Saturday, December 13, 2008

The phone call

I got a phone call yesterday that scared the wits out of me.

It was my clinical trial coordinator calling in reference to Tuesday's visit.

Like my mom, she takes forever to get to the point.

She starts out by saying "we got all your labwork back from your visit the other day..." and I'm thinking I'm about to find out something terrible. That maybe my liver enzymes were too high and I was going to be pulled from the trial. GET TO THE POINT! I wanted to scream.

Then she said "but something was wrong with your hemoglobin."

I'm enough of a hypochondriac that I know that means "blood".

I sit down with a "whump" as the air goes out of me and I collapse on the couch. I know I must have been stark white.

"Something's WRONG with my blood??" I ask.

"Yes, it was clotted and they couldn't perform the tests on it. It will have to be redrawn," she said.

"Whew!" was all I could say. "No big deal! Heh. When do you want me there?" I ask.

"Whenever you can make it up this way. Perhaps you need to come up to go Christmas shopping?" she said, trying to make the 4 hour round trip for a thimble full of blood sound appealing.

Little did she know that we are so freaking broke this Christmas that I guess I should bring my son with me for the trip so he knows that the gas money used to provide his *view* on the way is all he's getting from me this year.

I'm going back Monday and all I can say is Loreen better be back at work. She's the only one who can stick me and get blood the first try.

I knew I should have held out for making Novartis pay my gas money.

Friday, December 12, 2008

My first report card!

I woke up today and checked my email because my name is Jeri and I'm an internetaholic. For once there was a Google alert about FTY720 that wasn't from my own stupid blog.

I tore open the envelope (not really, but it sounds more dramatic then "I clicked the little line of text furiously") and found the first report from the Phase III clinical trials (that's me they're talking about).

Here's the whole story (click here).

I read it with this odd sense of pride mixed with curiosity. Like I was going to see my name mentioned or something. Or "1 patient experience this. And this, and this, and oh yeah, this."

"Her data was deemed contaminated by the fact that she is a scientifically proven hypochondriac so anything that spews forth from her facial orifice can only be taken with a grain of sodium."

Basel, December 12, 2008 - Initial results from the one-year Phase III TRANSFORMS study show the investigational oral compound FTY720 (fingolimod) has superior efficacy to a current standard of care for patients with relapsing-remitting multiple sclerosis (MS). Patients on oral FTY720 experienced significantly fewer relapses than those treated with the injectable medicine interferon beta-1a (Avonex®*)[1].

The study, the first one-year head-to-head Phase III trial against a standard of care in MS, met its primary endpoint for both doses of FTY720.

The annualized relapse rate at one year for patients given FTY720 0.5 mg was 0.16, representing a 52% reduction compared to a relapse rate of 0.33 for interferon beta-1a (p<0.001). The FTY720 1.25 mg dose also showed a significant reduction in relapses with a rate of 0.20 representing a 38% reduction against interferon beta-1a (p<0.001). No statistically significant difference was seen between the two FTY720 doses[1].

Comprehensive analyses of the TRANSFORMS study data are ongoing, and detailed results are planned to be presented at a leading scientific congress in 2009. Regulatory submissions remain on track to be completed in the US and EU at the end of 2009.

They didn't mention me at all. Go figure. They referred to us all as a group. No, more a statistical number. After all we have given of ourselves over the past year. I feel so cheap. Like I was just another notch on the ol' test tube.

Of course I'm kidding. I'm so excited I'm approaching giddiness.

So, I'm no rocket surgeon, so those percentages are a little confusing to me. I understand the part about Avonex having a 33% reduction in relapses. That's pretty straight forward. So, if I had 3 attacks a year I could expect to only have 2 while on Avonex, right?

The part I don't understand is the "52%" reduction in relapses that Fingolimod has over Avonex. It would seem to me that number is a percentage of Avonex's number. It's one of those math problems I always got wrong in school, so bear with me.

If Avonex users had 33% less attacks than someone who was on no treatment, and people who were on Fingolimod had 52% less attacks as compared to Avonex, then really the efficacy percentage for Fingolimod is what? 49%? I have no clue what that data told me. All I know is that it sounded good, right? It's good news?

But I'm bound and determined to understand this, so let's go back to school and figure it out....

If a train carrying 3 relapses is headed toward a tunnel going through a forest where a tree fell when nobody was around at a speed of 25 mph and Jane has a bottle of Fingolimod, how many relapses would still be on the train when it reaches the tunnel, IF nobody has yet claimed to have heard the tree fall?

Oh well, forget it. I thought I was getting someplace with all this, but I guess I'd just better be happy to know it *sounded* like good news. Fingolimod had a big number and Avonex had a smaller number. Big number good. I think.

Is it any wonder at ALL that, when my 10 year old came home with compound fractions to multiply, we ended up having to Google it? I will never forget, from now until the day I die, that it's numerator times numerator and denominator times denominator. I think.

Since Avonex is one of the current standards of treatment for MS, and many, many people take it hoping to lessen the severity of their disease, this is actually GREAT news about FTY720!!

Looking at the data report of the adverse events, I can now see why they were making such a big TaDoo over my little black moles I'd had all my life. 7 cases of skin cancer. That's nothing to sneeze at.

And I finally have clarification about the one poor fellow who ended up in a coma after the viral encephalitis. He must have died. It's rather sobering to realize that clinical trials can sometimes go terribly wrong.

That's the whole reason for us lab rats to volunteer. We offer up our bodies to be subjected to all the unknowns so that the FDA can say "Nope. Not safe for human consumption." and the masses are protected from something that might have hurt them.

I am doing it for a way less altruistic reason...I wanted something to slow this monster down for ME. If that ends up helping the rest of you, then I'm thrilled. But believe me, I didn't lie awake at night before entering the trial, tossing and turning because I wasn't helping blaze a trail to help all of MSkind. Nope, I was tossing and turning trying to get comfy when my spasticity and neuropathy were driving me nuts. I did it for me.

I'm just so happy that maybe a lot of other people will eventually be able to enjoy the same level of benefits I have from this stuff. From what the press release says, it's on track for submission to the FDA in 2009, so really people, it's not far off.

It really ISN'T the old "in the next 5 years." spiel we've all heard for the last 10. There really is a pill coming...and soon! Just hang in there.

Thursday, December 11, 2008

Visit Number 15

Gosh, I'm sorry I've become such a slacker about blogging. I hope I haven't lost my *knack* whatever that was.

I had visit number 15 on Tuesday and everything's still A-OK. AND...I've lost 4 lbs since my last visit which was only last week. yay! Removing your cell phone and not wearing a jacket really does help you lose weight!

I had the eye exam first and, since it is a teaching hospital, the doc had some students helping out. The first one was a lanky, shy young man who sat in on the contrast test. That's the one where you start out reading an eye chart that has black letters on a white background from 10 feet away, and then the contrast progressively lessens until you are reading glossy spots on dull white background. If the light isn't shining off it just right it's darn near impossible.

I mentioned this and she readjusted the chart so it wasn't reflecting the light at me and said "oh! we can't have any advantages or the test won't be an accurate representation." I have such a big mouth. The good thing is that by the end of the test I darn near have all the lines memorized (you do it with both eyes and then each eye separately). My luck is that I'm probably getting all the same ones wrong over and over because of it.

Then, I usually get the drops all and once and am left to *soak* for 10 or 20 min. This time was a little different. I got the work out with "how many fingers do you see" in my peripheral vision and then the color blind eye chart. I mentioned to this new student testing me that the tests assume I can both count and read. She just smiled at me nervously. I think they don't teach them how to handle smart-assed patients. Well, I think that's an important part of their training so I set about to make sure she learned something on Tuesday.

She put the numbing drops and the fluorescing yellow stuff in my eyes and then announced "I'm going to check your pressure." She didn't mention that the pressure she was really testing was to see how high my blood pressure could go before my eyes popped out of my head.

She apparently was new to the eyeball pressure test and when I was expecting the glowing purple ring to kiss my eye and back off, she had other plans. It made contact (which I couldn't feel on the surface) and then stayed there for a very long time. Then she'd back off and fiddle with the tip of the thing that goes against my eye trying to adjust it or something. I pulled my head back from the contraption you're supposed to keep your chin and forehead pressed against and saw her flicking her finger over the end of it repeatedly.

Without a shred of humor I asked if she planned on poking me in the eye again with that thing now that she mauled it. Apparently, I'm a stand-up comic who missed her calling because this girl actually laughed. When she realized I was serious, she got a Kleenex to wipe the tip off because any good doctor knows that a Kleenex is all you need to sterilize something and get all the cooties (that's a medical term) off it.

I sighed and presented my eyeball for another round of poke-her-in-the-eye. I actually could feel the additional pressure of it pushing against my eye. I mentioned to her that one time, years ago, I ended up on the floor of my eye doctor having smelling salts wafted under my nose to revive me from passing out when I was about to have the pressure test done. I think that made her nervous. She kept saying "You're doing fine. You're doing fine."

I told her "No, I'm doing excellent considering you AREN'T doing fine." By the time she moved to my left eye, she had it down. That took a whole second. I think I scared the poor girl into remembering something she read in her textbook or something.

After she was done, she put the dilation drops in my eyes and handed me a tissue, asking if there was anything she could get me. "A cold pack and an eye patch would be nice." She laughed and it was okay this time because that part was a joke....sort of.

The first student, the shy guy, came in and said he wanted to shine a light in my eyes and have a look. I said "sure."

I told him I wished I could do that. He said "what's that?"

I said "I wish I could look inside an eyeball. It must be cool to see, like a big empty ball that's all pink with veins and gunk."

It was like I had found the key to unlock this kid's personality. He started expounding on just how cool it was. You could tell he was going to make a terrific doctor just by how passionate he was about the eyeball.

We discussed the optic nerve and I was telling him that I had read in the last year or so about how it was considered to be the predictor (or maybe it was the gauge, I forget) of the severity of an MS patient's disease progress. The nerve apparently thins as the disease progresses. Don't ask me for the details because I have cognitive issues that go along with my MS and therefore all *facts* that enter my brain go through a process of being reformed into unrecognizable shapes before re-solidifying as something now carved in stone that has heretofore never been heard of. So, forgive me if I got the facts wrong about that optic nerve statement.

The student was fascinated and I'm sure he's going to get something wrong on his next test from having had that conversation with me.

The doctor came in and the rest of the test went smoothly. I was told again that I have dry eyes and to be using the tear drops. I keep forgetting that when my eyes feel sore and scratchy that it's because they are dry.

I have learned that other Fingo Heads (from our secret society meeting group with the special knock) also have dry eyes. At least one other person mentioned it. So now I'm wondering if it's a side effect. Fingolimod sucks the moisture out of your eyeballs. Hmmm Well, if that's all it does on the bad side (besides force me to eat dessert every night and slack off on exercising thus gaining weight) then I am okay with that.

Now, remind me that I have a whole 'nother post to write about the EDSS test. I hope my procrastination doesn't trump my memory so I don't put it off so long I forget the funny parts.

Back soon...I promise.