VOLUME 34 · ISSUE 3 · MARCH 2022
Visit AAN.com/Covid19 for the latest pandemic information and resources to support you and your crucial work.
ANNUAL MEETING ADVANCE REGISTRATION SAVINGS END MARCH 17!
Secure your advance registration discounts to the 2022 Annual Meeting taking place in person in Seattle this April 2–7, along with a distinct virtual option April 24–26 that will be offering different content. No matter which option you choose—or if you attend both—you
can expect a fresh lineup of education opportunities, the latest science from your peers, and the opportunity to reconnect with friends and colleagues. While registering, consider saving even more by registering for the Platinum
package, which offers 25-percent off both the in-person meeting and the virtual experience, with extended access to session recordings. Visit AAN.com/AM today to save! Continued on page 11
No-risk Cancellation Until March 17 Seattle: April 2 –7 Virtual Experience: April 24–26
Because attendee safety is our #1 priority, Annual Meeting cancellation policies have been updated to offer greater flexibility with extension of no-risk registration for the in-person meeting in Seattle. If your circumstances change, you can feel confident about getting your money back if you cancel your registration through March 17, 2022. If you decide to switch your registration to the virtual option, you can get a refund on the price difference through this date. Learn more at AAN.com/events/annual-meeting-registration#cancellation.
Apply by March 28 for Palatucci Advocacy Leadership Forum
Annual Meeting Abstracts Available March 3 Visit AAN.com/22Abstracts beginning March 3 at 4:00 p.m. ET to browse the innovations and discoveries of the more than 1,900 abstracts presented in person with another 470+ virtual abstracts that will be presented at the upcoming 2022 AAN Annual Meeting in Seattle. These impressive findings were chosen because they represent the most innovative scientific research and cutting-edge breakthroughs in all facets of neurology.
MARCH
The AAN Palatucci Advocacy Leadership Forum (PALF) will take place July 21 to 24, 2022, at the Hyatt Tamaya Resort in Albuquerque, NM. Apply today to take part in this awardwinning program, which offers critical training in the areas Continued on page 11
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CMS Proposes Limited Coverage of Aducanumab
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New Study Highlights Gender Disparities in Neurologist Compensation
14 Second Annual Health
Care Equity Symposium Set for Seattle
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AANnews · March 2022
March Highlights
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The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
The first recipient of the new General Neurology Award is Sally L. Harris, MD, FAAN, a solo general neurologist in Albuquerque, NM, for the past 12 years. The award is a new opportunity to recognize exemplary service, performance, and/or innovation by a general neurologist.
The Vision of the AAN is to be indispensable to our members. Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415
Harris
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Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:
memberservices@aan.com
Website: AAN.com
rowing Leadership Program G Alumni Community Increases Presence at Annual Meeting
The community’s presence will be more palpable than ever, with more than 80 Leadership Program graduates serving in a variety of roles, from course directors, speakers, and plenary session moderators to topic chairs and abstract reviewers involved in the development of the scientific program curriculum.
For advertising rates, contact: Michael J. O’Brien II Account/Relationship Manager Wolters Kluwer Phone: (978) 578-4514 Email:
Recipient Chosen for Inaugural General Neurology Award
Michael.Obrien @wolterskluwer.com
17 AAN Chief Executive Officer: Mary E. Post, MBA, CAE
Govindarajan Editor-in-Chief: Melissa W. Ko, MD, FAAN, CPE
Study Examines Different Methods of Virtual Neurology Clerkships
Intended for clerkship directors, program directors, or anyone teaching a neuroscience curriculum, the resource addresses the different methods of virtual instruction, hybrid models of clerkship training, and the challenges to its implementation, professionalism issues, and modification of feedback and assessment techniques specific to the virtual learning environment.
Managing Editor: Angela M. Babb, MS, CAE, APR Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designer: Siu Lee Email: aannews@aan.com AANnews® is published monthly by the American Academy of Neurology for its 36,000 members worldwide. Access this magazine and other AAN publications online at AAN.com.
News Briefs AAN in the News A Neurology® study suggesting exercise may prevent early Parkinson’s disease was covered by The Washington Post. The AAN’s position statement on ethical guidance on aducanumab was mentioned in the New York Times and was reprinted in Yahoo! The AAN’s guideline on painful diabetic neuropathy was covered by U.S. News & World Report.
The American Academy of Neurology ’s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States. The inclusion of advertisements and/or promotions of Sponsors and other Internet sites or resources that offer content, goods, or services on the Website does not imply endorsement of the advertised/promoted products or services by AAN.
PLEASE RECYCLE POLYBAG WHERE #5 PLASTIC IS ACCEPTED
Seattle: April 2 –7 Virtual Experience: April 24–26
Get Ready for the Great Neuro Reunion! Reunite with your neurology community from around the globe at the Annual Meeting to experience the most comprehensive educational offerings and largest scientific program in the field with options to participate in person, virtually, or both.
Learn more and register now at
AAN.com/AM.
PRESIDENT'S COLUMN In Honor of Those Who Teach Us Next month, we all will have an opportunity to engage in lifelong learning by attending lectures from educators from across the world at the 74th Annual Meeting of the American Academy of Neurology in Seattle. I already have bookmarked the programs I want to attend and hope that I will see you there. The new sessions are highlighted with yellow icons in the Education Program booklet and promise to bring fresh ideas since we last met three years ago, like the Post COVID Clinic directed by Sarah M. Benish, MD, FAAN, and the Epilepsy in Therapy Update directed by Joseph I. Sirven, MD, FAAN, both held at 3:30 p.m. on Monday, April 4. It makes me want to be in two places at once, but happily, those sessions will be available on demand after the meeting, along with many others, so I won’t have to try. I have been fortunate to have been taught by exceptional educators―like many of the course directors and speakers who will be present at the Washington State Convention Center―ones who supported and encouraged me during the most challenging times in my training. During my fourth-year neurology rotation, I was introduced to outpatient neurology by William (Bill) H. Jeffreys, MD, FAAN, at Geisinger Medical Center, who retired in 2015 at age 89 after 58 years of teaching. He left the legacy of launching the hospital’s neurology program in 1961 and founding the Geisinger Neuroscience Center in 1984. His humble nature belied his intellect, vision, and a multitude of accomplishments. He regaled me with a never-ending stream of neurologic clinical pearls of wisdom during our weekly one-hour drive to a satellite clinic. (When I nodded off on one occasion after being on call, he cheerfully described the architecture of sleep when I woke up and told me all about my hypnagogic jerks.) “As doctors, our gifts should include time spent teaching,” Dr. Jeffreys once told an interviewer when asked about his plans for trainees. “It is our responsibility to make certain that students are prepared to practice 21st century medicine. That is what the residency program will do.” Later, when I went to Yale to train in my own residency program, it was my good fortune to have been assigned another consummate educator, Jonathan H. Pincus, MD, as my neurology program director. When I think about him today, I most remember his gregarious nature. Dr. Pincus found humor and joy in the most mundane of encounters, greeting patients with peals of laughter, making the experience not only educational, but tremendous fun. He taught me not only about neurology, but about the value of a warm physician-patient relationship and the healing power of humor. A year after I finished my residency, he was appointed chairman of neurology at Georgetown University School of Medicine and in 2001, he served as chief of service at the Washington Veterans Administration Hospital, a position that he held until his death in 2015. His son, Adam, described meeting his father’s trainees in a Neurology ® article written after Dr. Pincus’ death by his Yale residents: “They didn't just admire your academic achievements; rather, they mainly appreciated your
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AANnews • March 2022
Avitzur
supportive, paternal, and heartwarming approach.” That was my experience; he made it his mission to encourage and praise young neurologists like me and overlooked our blunders and inexperience. Teachers like Dr. Jeffreys and Dr. Pincus are the reason we all go into neurology and our field is blessed with many exceptional ones. As we look forward to Match Day 2022 later this month, I would like to thank them for their dedication to the future of our pipeline and wish all my best to the medical students about to be welcomed into our field. I asked a few exemplary educators to share their thoughts about teaching and how they continue to engage, motivate, and support trainees through the challenges of a multi-year pandemic. I hope their words inspire you as they have me.
Orly Avitzur, MD, MBA, FAAN President, AAN oavitzur@aan.com @OrlyA on Twitter
The neurology clerkship transitioned to the fourth year of medical school in 2021. Now, students have the added stress of scheduling time out for interviews or isolation periods if they are exposed to or become sick with COVID. Therefore, to satisfy the clerkship educational goals, they can complete online modules used during the 2020 COVID-19 pandemic to make up for their missed clinical and didactic work. We no longer have lectures and our didactic sessions have transitioned to be 100-percent case-based, which promotes student participation and engagement. ―Miguel Chuquilin Arista, MD, FAAN
The key role of neurology clerkship and program directors during the pandemic is to be always available to support the residents and medical students so that patient care and teaching continue uninterrupted. This includes physically being present each day, listening attentively to their concerns, communicating medical center directives clearly and regularly, and ensuring that they have adequate PPE. The PD and CD are role models and how they react to the pandemic in many ways will determine how the residents and students react. It is also important to continue to plan social events within the guidelines imposed by the pandemic. ―Ralph F. Józefowicz, MD, FAAN
During this challenging marathon we’ve been running, we try to remind our residents that they are heroes. They are putting patients first through every wave of this pandemic, showing up, and caring for others. We discuss the importance of looking out for each other and caring for one another during this time as well. We work as a team, always. When it comes to keeping our trainees motivated, food is key. The mantra of our program is that food is love. It nourishes the soul and gives us the energy to keep moving forward! ―Arielle Kurzweil, MD
Teamwork, flexibility, and optimism have been key to successfully navigating the challenges of the ‘COVID era.’ Finding ways to be creative and celebrate successes and milestones have buoyed morale and fostered connectivity despite the social limitations imposed by COVID. For example, I welcomed our residency’s ‘first baby’ with a socially distanced baby shower for one of our residents, and events such as virtual games for board review have been well received. Additionally, the residents developed and launched a residency Instagram page, which has been a great platform to highlight wins and amplify the fun we have learning and growing together.
Educators and students alike have had to quickly integrate flexibility, demonstrate creativity, and develop resiliency to adapt to the changing learning environment during the pandemic. Silver linings include the accelerated implementation of virtual learning and assessment modalities, engagement of senior student ambassadors and resident teachers, and initiation of cross-institutional collaborations that will remain even after the pandemic to enhance program offerings. The virtual platform has also allowed SIGN chapters and educators to connect across borders to foster pipeline interest in neurology. Enthusiasm, however, for bedside teaching remains our most powerful tool to engage and motivate trainees. ―Madhu Soni, MD, FAAN
―Dalila W. Lewis, MD, FAAP
Mentoring and working with residents and medical students has been a bright spot in these last two years for me. The ability to bring enthusiasm and curiosity to the minds of learners is something that I feel privileged to be a part of. Protecting and supporting their education remains a big part of the job, and though it puts me at odds with hospital administration at times, it continues to be the right thing to do. ―Jose H. Posas, MD, FAAN
AANnews • March 2022
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PRACTICE CMS Proposes Limited Coverage of Aducanumab On January 11, the Centers for Medicare & Medicaid Services (CMS) released its proposed National Coverage Determination (NCD) relating to monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease (AD). This NCD is the culmination of a National Coverage Analysis that was triggered by the FDA’s approval of aducanumab (brand name Aduhelm) in June of 2021. The approval of aducanumab sparked significant controversy due to the accelerated approval pathway through which it was approved and questions over its clinical effectiveness and potential side effects, as well as financial impacts on the Medicare program and beneficiaries. CMS proposes to: Use a Coverage with Evidence Development to further study the drug. Amyloid therapies will only be covered by Medicare in the context of CMS-approved randomized controlled trials or trials supported by the NIH
not just aducanumab. Multiple therapies that would be affected by the NCD are working through the approval process right now Throughout the approval and coverage determination process, the AAN has engaged with the FDA, CMS, and other key stakeholders. This NCD realizes many of the AAN’s advocacy efforts such as coverage of PET to confirm amyloid positivity for prospective patients, limitation of coverage to patients with mild cognitive impairment or mild AD, further clinical trials to confirm clinical benefit, and more inclusive trial data to reflect the diverse patient population affected by AD. On January 26, the AAN met with officials from CMS to discuss the NCD. The AAN submitted comments in response to the NCD in February. CMS will announce a final decision by April 11. Find more information and resources on the Aducanumab Resources page at AAN.com.
Restrict trials to hospital-based outpatient facilities Require trials to meet diversity and inclusion standards to ensure traditionally underrepresented populations are not excluded Allow for one PET scan for amyloid in the patient’s lifetime to be performed on participating patients to confirm amyloid positivity Apply the coverage determination to all amyloid monoclonal antibody therapies for the treatment of AD,
AAN.com/aducanumab
PODCAST
Neurology ® Podcast:
20 Minutes Pack a Punch! Subscribe and download the latest podcast at Neurology.org/podcast
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AANnews • March 2022
The Impact of Benchmarking on MIPS Benchmarking is a method of comparing performance of organizations and providers to a predetermined standard. For MIPS, CMS sets the benchmark annually for quality measures that meet CMS’s 20 minimum case threshold. Each CMS submission method (e.g., Medicare Part B Claims, Clinical Quality Measure [CQM], eCQMs [electronic Clinical Quality Measures], CMS Web Interface, and registry measures) has specific benchmarks. This means providers reporting on the same measure will have different benchmarks depending on if they are reporting via claims, web interface, or Qualified Clinical Data Registry (QCDR) like the AAN’s Axon Registry®. CMS benchmarks are updated for each performance year. How can I earn points in the quality component? For the MIPS quality component, providers should be reporting six quality measures and at least one of these measures should be an outcome measure. If the participant does not use an outcome measure, a high-priority measure is required. Beginning in 2022, providers will no longer receive bonus points for reporting additional outcome and high-priority measures. CMS will award between zero to 10 points for each quality measure in MIPS submission depending on the participant’s performance. Starting in the 2022 performance period, new quality measures without benchmarks will receive between seven to 10 points for the first year in the program; this change is an incentive to use new measures for MIPS.
individual MIPS eligible clinician’s or group’s patients across all payers for the performance period. See table 1 below. Are there neurology measures with benchmarks? The Axon Registry has neurology-specific measures with benchmarks that may provide meaningful data for your patients and practice. These QCDR measures are currently only available in the Axon Registry. Examples of some of these measures and their current 2022 CMS benchmarks are provided below. Also, recall that starting in the 2022 performance period, new quality measures without benchmarks will receive between seven and 10 points for the first year in the program; this change is an incentive to utilize new measures for MIPS. See table 2 below.
How many points can I earn for a benchmarked Axon Registry measure? The available points for each measure will vary. Currently, there are multiple Axon Registry measures with benchmark data. Below is an example of a measure and potential points to be awarded based on 2022 CMS benchmark data. The decile corresponds with the points awarded for a measure assuming data completeness thresholds are met. In this example below, a performance value from 51.83 to 71.88 (in the 4th decile) will earn four points. For quality measures reported via a QCDR, MIPS CQMs, or eCQMs one must report on 70 percent of the
Where can I find Axon Registry measure benchmarks? The full list of 2022 quality benchmarks are available at the CMS Quality Payment Program (QPP) resource library at qpp.cms.gov/about/resource-library. The full benchmark file includes several scoring examples. CMS has more information on MIPS requirements at QPP.CMS.gov. Review the AAN’s most updated resources related to QPP and MIPS at AAN.com/qpp. For more information on how to join the Axon Registry, visit AAN.com/Axon or contact registry@aan.com.
Table 1 Measure Title
Decile 3
Decile 4
Decile 5 Decile 6
Decile 7
Decile 8
Decile 9
Decile 10
Average Performance Rate
Advanced Care Plan (MIPS CQM)
27.11– 51.82
51.83– 71.88
71.89– 85.04
93.53– 98.26
98.2799.76
99.77– 99.99
100.00
68.20
85.05– 93.52
Table 2 Measure Title
Decile 3
Decile 4
Decile 5 Decile 6
Decile 7
Decile 8
Decile 9
Decile 10
Medication Prescribed for Acute Migraine Attack (QCDR Measure)
47.33– 53.69
53.70– 57.15
57.16– 62.85
62.86– 67.36
67.37– 71.42
71.43– 76.34
76.35– 80.72
>= 80.73
Exercise and Appropriate Physical Activity Counseling for Patients with MS (QCDR Measure)
56.67– 67.79
67.80– 74.16
74.17– 80.02
80.03– 86.59
86.60– 91.52
91.53– 94.51
94.52– 98.97
>= 98.98
Querying and Follow-up About Symptoms of Autonomic Dysfunction for Patients with Parkinson's Disease (QCDR Measure)
38.82– 59.99
60.00– 70.19
70.20– 87.10
87.11– 91.68
91.69– 96.25
96.26– 97.33
97.34– 99.99
100.00
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PRACTICE New Study Highlights Gender Disparities in Neurologist Compensation An AAN study, “Gender Discrepancies in Neurologist Compensation,” published in the January 21, 2022, print issue of Neurology ®, finds women neurologists’ salaries still significantly lag behind mens, according to an analysis of the Academy’s 2019 Neurology Compensation and Productivity survey. Data from the Bureau of Labor Statistics shows that gender pay equality remains elusive given that women’s median weekly earnings in 2019 were 82 percent of men’s earnings. Previous studies have demonstrated that pay inequality is also widespread among physicians. The results of this AAN study show that despite adjustment for multiple confounding variables, gender-based disparities in compensation for neurologists persist. This retrospective, cross-sectional analysis adds to the existing body of evidence using data from the largest benchmarking survey dedicated to neurology and its subspecialties. Authors from the Practice Management and Technology and Health Services Research Subcommittees analyzed data from the AAN’s 2019 Neurology Compensation and Productivity survey. While the benchmarking survey wasn’t designed specifically to compare compensation between genders, the data contained thousands of AAN member responses making it possible to analyze and share this important information with neurologists. According to the new research, mean full-time equivalent (FTE) annual salary for all neurologists was $280,315, and mean standardized hourly compensation was $131. The estimated annual salary for women was 10.7 percent less (p ≤ 0.001, 95 percent confidence interval -4 percent to 16 percent) after controlling for race, region, years of practice, practice setting, call status, leadership role, and subspecialty-wage category. When broken down by years of practice, the highest earning women neurologists’ mean hourly wage (11 to 20 years of practice, $128/h) was less than that of all men neurologists except those with zero to five years of practice ($125/h). Though not the primary objective, the analysis revealed statistically significant relationships between compensation
and seven other variables: leadership role status, race (White compared to non-White), compensation method, practice setting, years in practice, call status, and subspecialty. This and other analyses are first steps in solving compensation disparities because they expose and define the extent of issues. However, the authors note that awareness is not enough. Mitigation strategies need to be implemented, studied, and shared to make true impact. The authors note the “value of a professional society in surveying its membership and helping to shed light on pay inequity among its members. Medical professional societies have a critical role in exposing gaps in treatment of its members by gender, race, and orientation…. As a recurring source of data that has grown in scope and participation since its inception, the Neurology Compensation and Productivity Survey has the potential to provide metrics to assess the impact of further interventions.” This analysis will help inform future iterations of the AAN’s Neurology Compensation and Productivity Survey, which is conducted biennially and is open to all AAN member US neurologists, advanced practice providers, and business administrators. Participants receive free access to the entire aggregated data. 2021 data is available now at AAN.com/ benchmark, and the next survey will launch in spring 2023. Authors of the study were Melissa Yu, MD, FAAN; Shannon A. Merillat, MLIS, MPH; Allison L. Weathers, MD, FAAN; David A. Evans, MBA; Rebecca A. Wolf, MBA; and John P. Ney, MD, MPH, FAAN. The manuscript was approved by the Medical Economics and Practice Committee and the AAN Boards of Directors.
March 26 Is Epilepsy Awareness Day
MARCH
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AANnews • March 2022
March 26 is recognized as Epilepsy Awareness Day. The AAN is proud to partner with the Epilepsy Foundation in support of its cooperative agreement with the CDC Epilepsy program: Improving Epilepsy Education, Systems of Care, and Health Outcomes through National and Community Partnerships. The goals of this initiative are to strengthen epilepsy systems of care, address inequities in epilepsy care, and improve patient outcomes. Visit AAN.com/EpilepsyResources to find a consolidated list of epilepsy resources for physicians, patients, caregivers, and the public, including seizure first aid certification and a 24/7 helpline.
AAN’s Care Model Case Study Library Expands The AAN supports neurologists and neurology advanced practice in their value-based care efforts by developing resources to boost practice transformation initiatives. The care model case study library houses narrative case studies featuring novel models and includes overviews of how the model works operationally and financially, how it differs from traditional fee-for-service models, and highlights changes to the provider experience, including work-life balance implications. Three new case studies have been added to the case study library in addition to two telehealth care model case studies from 2020. Explore the case studies related to: The “5C” Model on Comprehensive Coordinated Community-based Care of MS Patients Close to Home, featuring a unique public-private partnership in British Columbia, Canada The Multidisciplinary Pituitary Care Model at Brigham and Women’s Hospital
The Patient and Family-centered “Specialty Medical Home Model” at Neurabilities Healthcare Read, share, and download the case studies at AAN.com/CaseStudyLibrary. Send questions or direct interest in featuring your own care model in a future case study to practice@aan.com.
Recipient Chosen for Inaugural General Neurology Award The first recipient of the new General Neurology Award is Sally L. Harris, MD, FAAN, a solo general neurologist in Albuquerque, NM, for the past 12 years. Prior to this, Harris was in a large group practice for a decade. Harris is on the faculty of the neurology department at the University of New Mexico, Burrell Osteopathic College, and Texas Tech University, where she precepts medical students and neurology residents. She teaches neurology to UNM nurse practitioner students, and currently mentors three other female neurologists through the AAN’s Practice Leadership Program and the Women's Issues in Neurology Section. The General Neurology Award is a new opportunity to recognize general neurologists. Approved by the Board of Directors in 2021, this award is designed to recognize exemplary service, performance, and/or innovation by a general neurologist. “We are excited to present Dr. Harris with the first General Neurology Award,” said Brad C. Klein, MD, MBA, FAAN, member of the AAN Board of Directors and chair of the General Neurology Award Work Group. “As a dedicated clinician, teacher,
Harris innovator, advocate, and leader, she exemplifies the qualities of a general neurologist. It is our pleasure to give this award to someone who gives so much to others.”
“I am deeply honored to accept this award on behalf of all general neurologists,” said Harris. “I am grateful that the AAN recognizes the role we generalists play in delivering accessible care. It has been a privilege to develop long-term relationships with many patients. I see their remarkable grace as they live their lives in the face of illness. I thank the AAN for this award and dedicate it to my patients who showed me what it means to be a general neurologist.” The Board has approved additional new awards targeted to private practice members, which will be open for application in late summer 2022: Neurology Practice Award, designed to recognize the neurology private practice for excellence in quality clinical care and service to community Volunteer Service Award, designed to recognize a physician in private practice who provides volunteer services to patients, an organization, or their community without reimbursement or personal reward
GENERAL NEUROLOGY AWARD AANnews • March 2022
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ADVOCACY
Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.
Latest Advocacy News AAN President Orly Avitzur, MD, MBA, FAAN, published an op-ed in MedPage Today highlighting the AAN’s work to lower prescription drug prices. Avitzur was quoted in a press release from Sen. Amy Klobuchar (D-MN) expressing the AAN’s support for the Conrad 30 program, which helps bolster the US physician workforce in rural and underserved areas. On January 26, the AAN, along with the American Geriatric Society and the Society for Nuclear Medicine and Molecular Imaging, met with the Centers for Medicare & Medicaid Services (CMS) to discuss the recently proposed National Coverage Determination for aducanumab and other beta amyloid monoclonal antibody therapies for the treatment of Alzheimer’s disease. The AAN submitted comments on February 4. You can find more information on the Aducanumab Resources page on AAN.com. Applications for the 2022 Palatucci Advocacy Leadership Forum are now open. Interested members can learn more about the forum and application at AAN.com/PALF.
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AANnews • March 2022
Issue in Focus Every 90 days, the COVID-19 pandemic public health emergency (PHE) declaration must be renewed by Secretary of the Department of Health and Human Services. For now, extensions of the PHE are presumed and met with little fanfare. The significant easing of restrictions for treating Medicare beneficiaries via telehealth is only possible due to this public health declaration. Without it, most significant Medicare telehealth policies will revert to what they were pre-pandemic. At some point, the United States will no longer be in a pandemic which is good for population health, but terrible news for telemedicine. In recognition of this, last week hundreds of telehealth stakeholders, including the AAN, state neurosocieties, and patient advocacy organizations, demanded that Congress act soon to ensure Medicare telehealth flexibilities are maintained to provide muchneeded certainty to physicians and patients. This call was echoed by 35 senators and nine representatives, each of whom have been champions of telehealth over the years. Congress needed to pass legislation to continue to fund the government by February 18, 2022. This coalition has made it clear to Congress that we believe that policies to provide telehealth stability should be part of this legislative package.
Apply by March 28 for Palatucci Advocacy Leadership Forum continued from cover of grassroots advocacy, leadership, relationship building, and media skills to help you take a problem or issue and mold it into a strategic action plan. The Palatucci Advocacy Leadership Forum teaches neurologists how to: Promote state and federal legislation Be more confident in public speaking and in front of a camera Organize and reinvigorate state neurological societies Lobby for fair reimbursement Help draft position statements that affect future legislation Up to 30 advocates will be selected to participate in the forum, which was canceled due to the COVID-19 pandemic in 2020 and
held virtually in 2021. Note that the AAN is unable to accept international applicants this year. For more information and to submit your application by March 28, visit AAN.com/PALF. This program is supported in part by AbbVie.
EVENTS Annual Meeting Advance Registration Savings End March 17! continued from cover
Safety Is Our #1 Priority Because of our commitment to creating a safe and healthy environment in Seattle, all in-person attendees, exhibitors, press personnel, guests, and staff must complete the COVID-19 vaccination process with an acceptable vaccine and booster a minimum of seven days prior to the event, provide verification of full COVID-19 vaccination status, and wear a mask indoors or while attending any Annual Meetingrelated off-site event. Unvaccinated individuals may register for the virtual Annual Meeting experience. Learn more about our safety protocols at AAN.com/AMCOVID19. After registering for the 2022 Annual Meeting, download the AAN Conferences mobile app in the App Store or Google Play to begin planning for your experience in Seattle. Log in to the app using your AAN ID and password to access all features so you can build your personalized agenda and get reminders for upcoming sessions, access program slides and syllabi, use turn-by-turn directions to find your way to the next session, complete program evaluations to claim CME, and more!
AAN Conferences Mobile App Available Mid-March
Learn more at AAN.com/MobileApp. Seattle: April 2 –7 Virtual Experience: April 24–26
AANnews • March 2022
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Join us Wednesday, April 6, 2022, to support and celebrate breakthroughs in brain disease research.
Public Leadership in Neurology Award Recipients
Scientific Breakthrough Award Recipient
Seth Rogen & Lauren Miller Rogen
Stephen L. Hauser, MD
Ambassador Award Recipient Susannah Cahalan
Join us at the AAN Annual Meeting in Seattle for Commitment to Cures, the annual event that galvanizes the neurology community around the crucial need to support research. Don’t miss out on listening to extraordinary stories from people living with brain disease, important updates on our latest research studies, and special guests, including actor and comedian Seth Rogen and his wife, Lauren Miller Rogen. The event will also feature Susannah Cahalan, the New York Times bestselling author of Brain on Fire, and Dr. Stephen L. Hauser, who will be honored for his career-long commitment to understanding multiple sclerosis. Unable to attend in-person? Join us virtually!
Get your ticket when you register for the AAN Annual Meeting or at AmericanBrainFoundation.org/C2C2022
EVENTS Add the 2022 Exhibit Hall to Your Seattle ‘Must Do’ List While planning your week in Seattle, but sure and put the Exhibit Hall on your ‘must do’ list. The Annual Meeting Exhibit Hall is not your typical exhibit hall and it’s four days of the meeting you won’t want to miss! Set to kick off with an Opening Luncheon on Sunday, April 3, the Exhibit Hall will run through Wednesday, April 6. In addition to offering a wide array of opportunities to meet, mingle, and learn from pharmaceutical and medical device industry representatives, you’ll also find opportunities to: Connect with other health organizations throughout the Association Neighborhood Gather career resources and more during the Career Fair Preview the latest products and services at Vendor Booths
These social and networking events will follow our safety protocols and all exhibitors must complete the COVID-19 vaccination process with an acceptable vaccine and booster a minimum of seven days prior to the event.
Grab a free cup of joe and mingle at the Exhibit Hall Buzz Cafes Keep your devices charged in the comfort of the Exhibit Hall Charging Lounges In addition, the Exhibit Hall will feature these special social and networking events: Opening Luncheon Sunday, April 3, 11:30 a.m.–1:00 p.m. Exhibit Hall Networking Reception Monday, April 4, 4:00 p.m.–6:00 p.m.
Seattle: April 2 –7 Virtual Experience: April 24–26
Attend AAN Business Meeting The annual Business Meeting of the American Academy of Neurology will be held in Seattle, during the Annual Meeting, Saturday, April 2, from 4:00 p.m.–4:45 p.m. The session will feature reports on 2021 activities and finances from President Orly Avitzur, MD, FAAN; CEO Mary E. Post, MBA, CAE; and Treasurer Charles C. Flippen II, MD, FAAN. Avitzur
Post
Flippen
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EVENTS
Second Annual Health Care Equity Symposium Set for Seattle Inclusion is the reason the AAN was founded. To be an organization that is the home for all neurologists. It is what makes us stronger. To support our goal of being a fully inclusive, deliberately diverse, and anti-racist organization and our core values of Inclusion, Diversity and Equity, Anti-racism, and Social Justice (IDEAS), we are excited to share progress and updates with you. In today’s world, the reality is that access to quality health care varies greatly depending on race, gender, socioeconomic status, and many other factors. As part of its ongoing effort to explore ways to eliminate the disparity gap in neurology health care, the Academy will host its second annual Health Care Equity Symposium on Monday, April 4, from 1:00 p.m. to 5:30 p.m. during the 2022 Annual Meeting in Seattle. The session will feature presentations by LaShyra “ Lash” Nolen; Liliana Ramirez Gomez, MD; and Olajide A. Williams, MD, MS. The Cheryl A. Jay Keynote Lecture—named after the gifted clinical neurologist who was passionate about social justice in health care and serving the underprivileged—will be given by LaShyra Nolen, a third-year medical student at Harvard Medical School where she is currently serving as student council president (‘23), the first Black woman to serve in this leadership role. She is also the Founding Executive Director of We Got Us, a community empowerment organization committed to increasing vaccine and health care access for marginalized communities and a passionate advocate for equity and social justice. Gomez is an instructor in neurology at Harvard Medical School and assistant in neurology at the Massachusetts General Hospital (MGH), where she created a comprehensive neurology clinic focused on providing culturally sensitive care for Spanish-speaking patients. She is also part of the Multicultural Alzheimer’s Prevention Program faculty at MGH. Her research goals are to identify preclinical biomarkers for Alzheimer’s disease and related dementias and find ways to better assist underserved Spanish language people with dementia, including patients and their caregivers.
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AANnews • March 2022
Nolen
Gomez
Williams
Williams is currently a tenured professor of neurology, chief of staff of the Department of Neurology, and associate dean of Community Research at Columbia University. He is a global leader in community stroke prevention and community-based behavioral interventions for the youth, principal investigator of multiple health disparity-focused NIH investigator-initiated awards, and co-chair of Columbia University Irving Medical Center’s Anti-Racism Task Force. Williams has received many prestigious awards, including the European Stroke Research Foundation Investigator of the Year Award; Columbia University Outstanding Teacher of the Year award; a National Humanism in Medicine Award from the Association of American Medical Colleges; American Heart Association Trailblazer Award; Fast Company Most Creative 100 List; and has been a regular feature of the annual New York Magazine Best Doctors lists. He is founder and president of Hip Hop Public Health, an internationally recognized nonprofit organization that leverages music, art, and science for health promotion. Visit AAN.com/IDEAS for up-to-date information for all IDEAS-related programming at the Annual Meeting.
Growing Leadership Program Alumni Community Increases Presence at Annual Meeting
AAN
LEADERSHIP DEVELOPMENT
The AAN Leadership Program Alumni community continues to experience growth and is now comprised of an engaged group of more than 300 AAN members who are involved in various committees, subcommittees, work groups, and other important initiatives across the organization. The community’s presence will be more palpable than ever at the in-person Annual Meeting, with more than 80 Leadership Program graduates serving in a variety of roles, from course directors, speakers, and plenary session moderators to topic chairs and abstract reviewers involved in the development of the scientific program curriculum. Another area that will highlight important leadership work will be Leadership University, one of five areas within the new Learner Engagement Center. Making its debut in Seattle, the Learner Engagement Center will foster collaborative learning, offer unique education delivery methods, and spark engaging conversations. Leadership University will focus specifically on expanding neurology leadership development using methods of education, exposure, and engagement—with curriculum led by Leadership Program alumni themselves. Leadership University will also serve as a forum for social events and informal small group gatherings. If you’re looking for help determining which AAN Leadership Program might be the best fit for you, want to learn more about leadership development, or are a Leadership Program graduate looking to connect with your fellow graduates, make this a Seattle destination!
Visit These Other Learner Engagement Center Areas! In addition to the Leadership University area, be sure and visit these other Learner Engagement Center areas throughout your week in Seattle. Visit AAN.com/AM for more information and program schedules. Academic Exchange—offering career development, coaching, small group dialogue sessions, and networking opportunities across academic neurology professional career stages. Practice and Policy Engagement Center—providing inclusive tools in practice management, quality improvement, and advocacy to support high-quality care, improve efficiency, and increase revenue. Research Connections—offering researcher resources, inspiration for future research, and connection with other researchers. The Neuro Trainee and Educator Junction—sharing information and resources and connecting trainees and educators.
See a full Leadership University schedule at AAN.com/AMProgram. To learn more about the AAN’s Leadership Programs, visit AAN.com/Lead.
AAN LEADERSHIP UNIVERSITY
Abstract Submissions Open this Month for New AAN Summer Conference Abstract submissions will open later this month for the new AAN Summer Conference: Autoimmune Neurology and Neurology Year in Review taking place July 15 through 16, 2022, at the San Francisco Marriott Marquis. Submit your abstracts by May 3 at 11:59 p.m. CT for the chance to present your research at this exciting new offering. This new two-day conference will focus on autoimmune neurology and will also feature a neurology year in review. Previously presented abstracts will be accepted, and the submission fee is $50 for AAN members and $100 for nonmembers. Submission is free for residents and medical students. For more information, contact science@aan.com. Interested in attending? Registration will open in late April! AANnews • March 2022
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RESEARCH
Stay Current, Enhance Your Expertise
Mayo Clinic Team Selected as Recipients of 2022 Cure One, Cure Many Award A team of Mayo Clinic investigators led by Owen A. Ross, PhD; Pamela J. McLean, PhD; and Bradley F. Boeve, MD, has been named the recipients of the American Brain Foundation’s 2022 Cure One, Cure Many Award: A Research Award for Early Diagnosis of Lewy Body Dementia. The $3 million, multi-year grant was created to improve the diagnosis of Lewy body dementia (LBD).
Ross
“This groundbreaking award will provide critical support for scientific investigators working to find a biomarker (diagnostic test) for LBD, leading to improved diagnosis and treatment options for the second most common form of dementia,” said AAN President Orly Avitzur, MD, MBA, FAAN. “I am excited to see how the team’s work will propel brain research forward.”
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“We are so honored to receive the Cure One, Cure Many Award from the American Brain Foundation, the Alzheimer’s Association, The Michael J. Fox Foundation for Parkinson’s Research, and the American Academy of Neurology,” said Ross. “The combined efforts of the four award partners represent a unique combination of forward-thinking, research-positive organizations who appreciate the entire spectrum of the disease entity—from understanding first and foremost the patient’s view, through the challenges faced by neurologists, to the complexity of resolving the disease mechanisms and designing therapies that confront the basic scientist and pharma. These organizations appreciate the need for the ‘high risk, high reward’ approach to science that other funding agencies may shy away from. Furthermore, our focus on how one or more blood-based biomarkers can potentially impact early diagnosis/detection in a broad and generalizable manner, and be useful in tracking disease progression and hence be critical for clinical trials, are entirely consistent with a key mission of the AAN (i.e., ‘dedicated to promoting the highest quality patient-centered neurologic care’), The Michael J. Fox Foundation (i.e., ‘accelerate the next generation of Parkinson's disease treatments’), the Alzheimer’s Association (i.e., ‘envisioning a world without Alzheimer’s and dementia’), and the American Brain Foundation (i.e., ‘founded to bring researchers and donors together to cure brain diseases and disorders’).” The American Brain Foundation’s Cure One, Cure Many program provides large-scale catalyst funding to the world’s top researchers for multiple disease areas. Visit AmericanBrainFoundation.org/cocm to learn more.
EDUCATION Study Examines Different Methods of Virtual Neurology Clerkships The AAN published the article, "Accelerated Implementation of a Virtual Neurology Clerkship Amid a Global Crisis," in the December 17 online issue of Neurology®. Intended for clerkship directors, program directors, or anyone teaching a neuroscience curriculum, the resource addresses the different methods of virtual instruction, hybrid models of clerkship training, and the challenges to its implementation, professionalism issues, and modification of feedback and assessment techniques specific to the virtual learning environment. The standard neurology clinical experience in medical school focuses primarily on bedside patient encounters; however, the limitations of the clinical environment due to the current COVID-19 pandemic accelerated the need for virtual curriculum development. “Programs didn’t have a model on how to do telemedicine with students,” said author Raghav Govindarajan, MD, FAAN, member of the Undergraduate Education Subcommittee. “Clerkship directors were asking the AAN Consortium of Neurology Clerkship
Directors for input on how to do a telemedicine training with students; [our] goal was to provide resources in a succinct manner and to provide a model for use.” While the authors hope that the resource will have a long-term impact—and plans are in place to solicit feedback from program directors on the effectiveness—Govindarajan is quick to point out that “this by no means replaces the in-person clerkship experience, but provides a hybrid model.”
“Clerkship directors still don’t know how to effectively engage students through telemedicine— they can teach them, show them Govindarajan the neuro exam, ask questions, but how do they keep them engaged via telemedicine?” he added. Visit Neurology.org to see the full article.
Applications Now Open for Autonomic Disorders Certification Examination Applications are now open for the United Council for Neurologic Subspecialties Autonomic Disorders Certification Examination. The application deadline is June 1, 2022, and the four-hour, 200-multiple-choice question examination is scheduled to take place
online November 28 to December 2, 2022, with live virtual proctoring. Visit UCNS.org/certification for access to the online application form, to see the complete certification eligibility criteria, and the examination content outline.
UCNS Invites Diplomates to Help Identify 2023 Continuous Certification Reading List The United Council for Neurologic Subspecialities is engaging each of its neurologic subspecialties in the process of identifying the most important developments in their subspecialty field. All certified diplomates and the subspecialty sponsoring organizations are encouraged to submit journal articles or practice guidelines that meet the submission criteria for the 2023 Continuous Certification (C-cert) reading list. All submissions will be reviewed by the subspecialty’s examination committee, a committee of subject matter experts who are nominated by the subspecialty’s sponsoring organization(s). Committee members may include additional articles that are not included in the original submissions.
C-cert activities provide subspecialty learning and knowledge assessment to ensure that diplomates are staying up to date on the latest science, treatments, and therapeutics relating to their subspecialty and include completing the reading lists and taking and passing the 25-question online post-reading quiz to assess knowledge gained from the journal article content. UCNS certification is continuous and does not expire when diplomates meet the annual C-cert requirements. Learn more and access the C-cert reading list submission criteria at UCNS.org/ArticleSubmission.
AANnews • March 2022
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FOR PATIENTS WITH RELAPSING FORMS OF MS
PLAYING WITH FEWER RELAPSES • The efficacy of VUMERITY® (diroximel fumarate) is based upon bioavailability studies in patients with relapsing forms of multiple sclerosis and healthy subjects comparing dimethyl fumarate to VUMERITY1 • Study 1: A 2-year, randomized, double-blind, placebo-controlled study in 1234 patients with RRMS. Primary endpoint: PPR1 • Study 2: A 2-year, multicenter, randomized, double-blind, placebo-controlled study in 1417 patients with RRMS. Primary endpoint: ARR1
VUMERITY offers the efficacy demonstrated by dimethyl fumarate across 2 pivotal trials1
of treated patients were relapse-free at 2 years1
• Dimethyl fumarate demonstrated a 49% and 34% relative risk reduction in PPR vs placebo, respectively (27% vs 46%; P<0.0001), (29% vs 41%; P=0.0020)
Based on ARR, treated patients experienced
RELAPSE every 2 years1
• Dimethyl fumarate demonstrated a 53% and 44% relative reduction in ARR vs placebo, respectively (0.172 vs 0.364; P<0.0001), (0.224 vs 0.401; P<0.0001)
Visit www.vumerityhcp.com
Indication VUMERITY® (diroximel fumarate) is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
Important Safety Information CONTRAINDICATIONS
VUMERITY is contraindicated in patients • With known hypersensitivity to diroximel fumarate, dimethyl fumarate, or to any of the excipients of VUMERITY. Reactions may include anaphylaxis and angioedema • Taking dimethyl fumarate
WARNINGS AND PRECAUTIONS
Anaphylaxis and Angioedema • VUMERITY can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Signs and symptoms in patients taking dimethyl fumarate (which has the same active metabolite as VUMERITY) have included difficulty breathing, urticaria, and swelling of the throat and tongue. Patients should be instructed to discontinue VUMERITY and seek immediate medical care should they experience signs and symptoms of anaphylaxis or angioedema
Progressive Multifocal Leukoencephalopathy • Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with dimethyl fumarate (which has the same active metabolite as VUMERITY). PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received dimethyl fumarate for 4 years while enrolled in a clinical trial • PML has occurred in patients taking dimethyl fumarate in the postmarketing setting in the presence of lymphopenia (<0.9 × 109/L). While the role of lymphopenia in these cases is uncertain, the PML cases have occurred predominantly in patients with lymphocyte counts <0.8×109/L persisting for more than 6 months • At the first sign or symptom suggestive of PML, withhold VUMERITY and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes
Important Safety Information (cont'd) WARNINGS AND PRECAUTIONS (CONT'D)
Progressive Multifocal Leukoencephalopathy (cont'd) • Magnetic resonance imaging (MRI) findings may be apparent before clinical signs or symptoms. Monitoring with MRI for signs consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present Herpes Zoster and Other Serious Opportunistic Infections • Serious cases of herpes zoster have occurred in patients treated with dimethyl fumarate (which has the same active metabolite as VUMERITY), including disseminated herpes zoster, herpes zoster ophthalmicus, herpes zoster meningoencephalitis, and herpes zoster meningomyelitis. These events may occur at any time during treatment. Monitor patients on VUMERITY for signs and symptoms of herpes zoster. If herpes zoster occurs, appropriate treatment for herpes zoster should be administered • Other serious opportunistic infections have occurred with dimethyl fumarate, including cases of serious viral (herpes simplex virus, West Nile virus, cytomegalovirus), fungal (Candida and Aspergillus), and bacterial (Nocardia, Listeria monocytogenes, Mycobacterium tuberculosis) infections. These infections have been reported in patients with reduced absolute lymphocyte counts (ALC) as well as in patients with normal ALC. These infections have affected the brain, meninges, spinal cord, gastrointestinal tract, lungs, skin, eye, and ear. Patients with symptoms and signs consistent with any of these infections should undergo prompt diagnostic evaluation and receive appropriate treatment • Consider withholding VUMERITY treatment in patients with herpes zoster or other serious infections until the infection has resolved Lymphopenia • VUMERITY may decrease lymphocyte counts. In the MS placebo-controlled trials with dimethyl fumarate (which has the same active metabolite as VUMERITY), mean lymphocyte counts decreased by approximately 30% during the first year of treatment with dimethyl fumarate and then remained stable. Four weeks after stopping dimethyl fumarate, mean lymphocyte counts increased but did not return to baseline. The incidence of infections and serious infections was similar in patients treated with dimethyl fumarate or placebo. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8 x 109/L or ≤0.5 x 109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5 x 109/L for 3.5 years) • In controlled and uncontrolled clinical trials with dimethyl fumarate, 2% of patients experienced lymphocyte counts <0.5 x 109/L for at least six months, and in this group the majority of lymphocyte counts remained <0.5 x 109/L with continued therapy. Neither VUMERITY nor dimethyl fumarate have been studied in patients with preexisting low lymphocyte counts • Obtain a complete blood count (CBC), including lymphocyte count, before initiating treatment with VUMERITY, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of VUMERITY in patients with lymphocyte counts less than 0.5 x 109/L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if VUMERITY is discontinued or interrupted because of lymphopenia. Consider withholding treatment from patients with serious infections until resolution Liver Injury • Clinically significant cases of liver injury have been reported in patients treated with dimethyl fumarate (which has the same active metabolite as VUMERITY) in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment with dimethyl fumarate. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities © 2021 Biogen. All rights reserved. 07/21 VUM-US-0458 v4
resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients • Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials with dimethyl fumarate • Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with VUMERITY and during treatment as clinically indicated. Discontinue VUMERITY if clinically significant liver injury induced by VUMERITY is suspected Flushing • VUMERITY may cause flushing (e.g., warmth, redness, itching, and/or burning sensation). In clinical trials of dimethyl fumarate (which has the same active metabolite as VUMERITY), 40% of dimethyl fumarate-treated patients experienced flushing. Flushing symptoms generally began soon after initiating dimethyl fumarate and usually improved or resolved over time. In the majority of patients who experienced flushing, it was mild or moderate in severity. Three percent (3%) of patients discontinued dimethyl fumarate for flushing and <1% had serious flushing symptoms that were not life-threatening but led to hospitalization
ADVERSE REACTIONS • The most common adverse reactions (incidence ≥10% and ≥2% more than placebo) for dimethyl fumarate (which has the same active metabolite as VUMERITY) were flushing, abdominal pain, diarrhea, and nausea • Gastrointestinal adverse reactions: Dimethyl fumarate caused GI events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). The incidence of GI events was higher early in the course of treatment (primarily in month 1) and usually decreased over time in patients treated with dimethyl fumarate compared with placebo. Four percent (4%) of patients treated with dimethyl fumarate and less than 1% of placebo patients discontinued due to gastrointestinal events. The incidence of serious GI events was 1% in patients treated with dimethyl fumarate • Hepatic transaminases: An increased incidence of elevations of hepatic transaminases in patients treated with dimethyl fumarate was seen primarily during the first six months of treatment and most patients with elevations had levels <3 times the upper limit of normal (ULN) during controlled trials. There were no elevations in transaminases ≥ 3 times the ULN with concomitant elevations in total bilirubin >2 times the ULN. Discontinuations due to elevated hepatic transaminases were <1% and were similar in patients treated with dimethyl fumarate or placebo • Eosinophilia adverse reactions: A transient increase in mean eosinophil counts was seen during the first 2 months of therapy
USE IN SPECIFIC POPULATIONS
Renal Impairment • No dosage adjustment is necessary in patients with mild renal impairment. Because of an increase in the exposure of a major metabolite, use of VUMERITY is not recommended in patients with moderate or severe renal impairment Please see following pages for Brief Summary of full Prescribing Information. PPR=proportion of patients relapsed; ARR=annualized relapse rate. Reference: 1. VUMERITY Prescribing Information, Biogen, Cambridge, MA.
VUMERITY® (diroximel fumarate) delayed-release capsules, for oral use Brief Summary of full Prescribing Information 1. INDICATIONS AND USAGE VUMERITY is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsingremitting disease, and active secondary progressive disease, in adults. 2. DOSAGE AND ADMINISTRATION 2.1 Blood Tests Prior to Initiation of VUMERITY Obtain the following prior to treatment with VUMERITY: • A complete blood cell count (CBC), including lymphocyte count [see Warnings and Precautions (5.4)] • Serum aminotransferase, alkaline phosphatase, and total bilirubin levels [see Warnings and Precautions (5.5)] 2.2 Dosing Information The starting dosage for VUMERITY is 231 mg twice a day orally. After 7 days, the dosage should be increased to the maintenance dosage of 462 mg (administered as two 231 mg capsules) twice a day orally. Temporary dosage reductions to 231 mg twice a day may be considered for individuals who do not tolerate the maintenance dosage. Within 4 weeks, the recommended dosage of 462 mg twice a day should be resumed. Discontinuation of VUMERITY should be considered for patients unable to tolerate return to the maintenance dosage. Administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to VUMERITY dosing may reduce the incidence or severity of flushing [see Clinical Pharmacology (12.3)]. 2.3 Administration Instructions Swallow VUMERITY capsules whole and intact. Do not crush or chew, or sprinkle the capsule contents on food. If taken with food, avoid a high-fat, high-calorie meal/snack; the meal/snack should contain no more than 700 calories and no more than 30 g fat [see Warnings and Precautions (5.6) and Clinical Pharmacology (12.3)]. Avoid co-administration of VUMERITY with alcohol [see Clinical Pharmacology (12.3)].
of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received dimethyl fumarate for 4 years while enrolled in a clinical trial. During the clinical trial, the patient experienced prolonged lymphopenia (lymphocyte counts predominantly <0.5 × 109/L for 3.5 years) while taking dimethyl fumarate [see Warnings and Precautions (5.4)]. The patient had no other identified systemic medical conditions resulting in compromised immune system function and had not previously been treated with natalizumab, which has a known association with PML. The patient was also not taking any immunosuppressive or immunomodulatory medications concomitantly. PML has also occurred in patients taking dimethyl fumarate in the postmarketing setting in the presence of lymphopenia (<0.9 × 109/L). While the role of lymphopenia in these cases is uncertain, the PML cases have occurred predominantly in patients with lymphocyte counts <0.8×109/L persisting for more than 6 months. At the first sign or symptom suggestive of PML, withhold VUMERITY and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. Magnetic resonance imaging (MRI) findings may be apparent before clinical signs or symptoms. Cases of PML diagnosed based on MRI findings and the detection of JCV DNA in the cerebrospinal fluid in the absence of clinical signs or symptoms specific to PML, have been reported in patients treated with other MS medications associated with PML. Many of these patients subsequently became symptomatic with PML. Therefore, monitoring with MRI for signs that may be consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present. Lower PML-related mortality and morbidity have been reported following discontinuation of another MS medication associated with PML in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. It is not known whether these differences are due to early detection and discontinuation of MS treatment or due to differences in disease in these patients.
2.4 Blood Tests to Assess Safety After Initiation of VUMERITY Obtain a complete blood cell count (CBC), including lymphocyte count, 6 months after initiation of VUMERITY and then every 6 to 12 months 5.3 Herpes Zoster and Other Serious Opportunistic Infections thereafter, as clinically indicated [see Warnings and Precautions (5.4)]. Serious cases of herpes zoster have occurred in patients treated Obtain serum aminotransferase, alkaline phosphatase, and total with dimethyl fumarate (which has the same active metabolite as bilirubin levels during treatment with VUMERITY, as clinically indicated VUMERITY) including disseminated herpes zoster, herpes zoster ophthalmicus, herpes zoster meningoencephalitis, and herpes zoster [see Warnings and Precautions (5.5)]. meningomyelitis. These events may occur at any time during treatment. 2.5 Patients With Renal Impairment Monitor patients on VUMERITY for signs and symptoms of herpes No dosing adjustment is recommended in patients with mild renal zoster. If herpes zoster occurs, appropriate treatment for herpes zoster impairment. should be administered. VUMERITY is not recommended in patients with moderate or severe Other serious opportunistic infections have occurred with dimethyl renal impairment [see Use in Specific Populations (8.6) and Clinical fumarate, including cases of serious viral (herpes simplex virus, Pharmacology (12.3)]. West Nile virus, cytomegalovirus), fungal (Candida and Aspergillus), and bacterial (Nocardia, Listeria monocytogenes, Mycobacterium 3. DOSAGE FORMS AND STRENGTHS These infections have been reported in VUMERITY is available as hard, delayed-release capsules containing tuberculosis) infections. 231 mg of diroximel fumarate. The capsules have a white cap and a patients with reduced absolute lymphocyte counts (ALC) as well as in patients with normal ALC. These infections have affected the brain, white body, printed with “DRF 231 mg” in black ink on the body. meninges, spinal cord, gastrointestinal tract, lungs, skin, eye, and 4. CONTRAINDICATIONS ear. Patients with symptoms and signs consistent with any of these VUMERITY is contraindicated in patients infections should undergo prompt diagnostic evaluation and receive • With known hypersensitivity to diroximel fumarate, dimethyl appropriate treatment. fumarate, or to any of the excipients of VUMERITY. Reactions Consider withholding VUMERITY treatment in patients with herpes may include anaphylaxis and angioedema [see Warnings and zoster or other serious infections until the infection has resolved [see Precautions (5.1)]. Adverse Reactions (6.2)]. • Taking dimethyl fumarate [see Drug Interactions (7.1)]. 5.4 Lymphopenia 5. WARNINGS AND PRECAUTIONS VUMERITY may decrease lymphocyte counts. In the MS placebo5.1 Anaphylaxis and Angioedema controlled trials with dimethyl fumarate (which has the same active VUMERITY can cause anaphylaxis and angioedema after the first metabolite as VUMERITY), mean lymphocyte counts decreased by dose or at any time during treatment. Signs and symptoms in patients approximately 30% during the first year of treatment with dimethyl taking dimethyl fumarate (which has the same active metabolite as fumarate and then remained stable. Four weeks after stopping dimethyl VUMERITY) have included difficulty breathing, urticaria, and swelling fumarate, mean lymphocyte counts increased but did not return to of the throat and tongue. Patients should be instructed to discontinue baseline. Six percent (6%) of dimethyl fumarate patients and <1% of VUMERITY and seek immediate medical care should they experience placebo patients experienced lymphocyte counts <0.5 × 109/L (lower signs and symptoms of anaphylaxis or angioedema. limit of normal 0.91 × 109/L). The incidence of infections (60% vs 58%) and serious infections (2% vs 2%) was similar in patients treated with 5.2 Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) has occurred in dimethyl fumarate or placebo, respectively. There was no increased infections observed in patients with lymphocyte patients with MS treated with dimethyl fumarate (which has the same incidence of serious 9 9 active metabolite as VUMERITY). PML is an opportunistic viral infection counts <0.8 × 10 /L or ≤0.5 × 10 /L in controlled trials, although one
patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5 × 109/L for 3.5 years) [see Warnings and Precautions (5.2)]. In controlled and uncontrolled clinical trials with dimethyl fumarate, 2% of patients experienced lymphocyte counts <0.5 × 109/L for at least six months, and in this group the majority of lymphocyte counts remained <0.5 × 109/L with continued therapy. Neither VUMERITY® (diroximel fumarate) nor dimethyl fumarate have been studied in patients with preexisting low lymphocyte counts. Obtain a complete blood count (CBC), including lymphocyte count, before initiating treatment with VUMERITY, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of VUMERITY in patients with lymphocyte counts less than 0.5 × 109/L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if VUMERITY is discontinued or interrupted because of lymphopenia. Consider withholding treatment from patients with serious infections until resolution. Decisions about whether or not to restart VUMERITY should be individualized based on clinical circumstances.
The data described in the following sections were obtained using dimethyl fumarate delayed-release capsules, which has the same active metabolite as VUMERITY. Adverse Reactions in Placebo-Controlled Trials with Dimethyl Fumarate In the two well-controlled studies demonstrating effectiveness, 1529 patients received dimethyl fumarate with an overall exposure of 2244 person-years [see Clinical Studies (14)]. The adverse reactions presented in Table 1 below are based on safety information from 769 patients treated with dimethyl fumarate 240 mg twice a day and 771 placebo-treated patients. The most common adverse reactions (incidence ≥10% and ≥2% more than placebo) for dimethyl fumarate were flushing, abdominal pain, diarrhea, and nausea. Table 1: Adverse Reactions in Study 1 and 2 Reported for Dimethyl Fumarate at ≥2% Higher Incidence than Placebo
Adverse Reactions
Dimethyl Fumarate 240 mg Twice Daily (N=769) %
Placebo (N=771)%
5.5 Liver Injury Clinically significant cases of liver injury have been reported in patients 40 6 treated with dimethyl fumarate (which has the same active metabolite Flushing as VUMERITY) in the postmarketing setting. The onset has ranged Abdominal pain 18 10 from a few days to several months after initiation of treatment with 14 11 dimethyl fumarate. Signs and symptoms of liver injury, including Diarrhea elevation of serum aminotransferases to greater than 5-fold the upper Nausea 12 9 limit of normal and elevation of total bilirubin to greater than 2-fold Vomiting 9 5 the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required Pruritus 8 4 hospitalization. None of the reported cases resulted in liver failure, Rash 8 3 liver transplant, or death. However, the combination of new serum 6 4 aminotransferase elevations with increased levels of bilirubin caused Albumin urine present by drug-induced hepatocellular injury is an important predictor of Erythema 5 1 serious liver injury that may lead to acute liver failure, liver transplant, Dyspepsia 5 3 or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times Aspartate aminotransferase 4 2 the upper limit of normal) were observed during controlled trials with increased dimethyl fumarate [see Adverse Reactions (6.1)]. Lymphopenia 2 <1 Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with VUMERITY and during Gastrointestinal treatment, as clinically indicated. Discontinue VUMERITY if clinically Dimethyl fumarate caused GI events (e.g., nausea, vomiting, diarrhea, significant liver injury induced by VUMERITY is suspected. abdominal pain, and dyspepsia). The incidence of GI events was higher early in the course of treatment (primarily in month 1) and 5.6 Flushing VUMERITY may cause flushing (e.g., warmth, redness, itching, and/ usually decreased over time in patients treated with dimethyl fumarate or burning sensation). In clinical trials of dimethyl fumarate (which has compared with placebo. Four percent (4%) of patients treated with the same active metabolite as VUMERITY), 40% of dimethyl fumarate- dimethyl fumarate and less than 1% of placebo patients discontinued treated patients experienced flushing. Flushing symptoms generally due to gastrointestinal events. The incidence of serious GI events was began soon after initiating dimethyl fumarate and usually improved 1% in patients treated with dimethyl fumarate. or resolved over time. In the majority of patients who experienced Hepatic Transaminases flushing, it was mild or moderate in severity. Three percent (3%) of An increased incidence of elevations of hepatic transaminases in patients discontinued dimethyl fumarate for flushing and <1% had patients treated with dimethyl fumarate was seen primarily during serious flushing symptoms that were not life-threatening but led the first six months of treatment, and most patients with elevations to hospitalization. had levels <3 times the upper limit of normal (ULN) during controlled Administration of VUMERITY with food may reduce the incidence of trials. Elevations of alanine aminotransferase and aspartate flushing [see Dosage and Administration (2.3)]. Studies with dimethyl aminotransferase to ≥3 times the ULN occurred in a small number of fumarate show that administration of non-enteric coated aspirin (up to patients treated with both dimethyl fumarate and placebo and were a dose of 325 mg) 30 minutes prior to dosing may reduce the incidence balanced between groups. There were no elevations in transaminases or severity of flushing [see Clinical Pharmacology (12.3)]. ≥3 times the ULN with concomitant elevations in total bilirubin >2 times the ULN. Discontinuations due to elevated hepatic transaminases 6. ADVERSE REACTIONS The following important adverse reactions are described elsewhere were <1% and were similar in patients treated with dimethyl fumarate or placebo. in labeling: • Anaphylaxis and Angioedema [see Warnings and Precautions (5.1)] Eosinophilia • Progressive Multifocal Leukoencephalopathy [see Warnings and A transient increase in mean eosinophil counts was seen during the Precautions Section (5.2)] first 2 months of therapy. • Herpes Zoster and Other Serious Opportunistic Infections [see Adverse Reactions in Clinical Studies with VUMERITY Warnings and Precautions (5.3)] In clinical studies assessing safety in patients with RRMS, approximately • Lymphopenia [see Warnings and Precautions (5.4)] 700 patients were treated with VUMERITY and approximately • Liver Injury [see Warnings and Precautions (5.5)] 490 patients received more than 1 year of treatment with VUMERITY. • Flushing [see Warnings and Precautions (5.6)] The adverse reaction profile of VUMERITY was consistent 6.1 Clinical Trials Experience with the experience in the placebo-controlled clinical trials with Because clinical trials are conducted under widely varying conditions, dimethyl fumarate. adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may 6.2 Postmarketing Experience The following adverse reaction has been identified during post approval not reflect the rates observed in clinical practice.
use of dimethyl fumarate. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Liver function abnormalities (elevations in transaminases ≥3 times ULN with concomitant elevations in total bilirubin >2 times ULN) have been reported following dimethyl fumarate administration in post marketing experience [see Warnings and Precautions (5.5)]. Herpes zoster infection and other serious opportunistic infections have been reported with dimethyl fumarate administration in postmarketing experience [See Warnings and Precautions (5.3)]. 8. USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary There are no adequate data on the developmental risk associated with the use of VUMERITY® (diroximel fumarate) or dimethyl fumarate (which has the same active metabolite as VUMERITY) in pregnant women. In animal studies, administration of diroximel fumarate during pregnancy or throughout pregnancy and lactation resulted in adverse effects on embryofetal and offspring development (increased incidences of skeletal abnormalities, increased mortality, decreased body weights, neurobehavioral impairment) at clinically relevant drug exposures [see Data]. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown.
17. PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information). Dosage and Administration Inform patients that they will be provided a starter dose bottle: one capsule twice a day for the first 7 days and then two capsules twice a day thereafter. Advise patients to take VUMERITY as instructed. Inform patients to swallow VUMERITY capsules whole and intact. Inform patients to not crush, chew, or sprinkle capsule contents on food. Inform patients that they should avoid a high-fat, high-calorie meal/snack at the time they take VUMERITY. If taken with food, the meal/snack should contain no more than 700 calories and no more than 30 g fat. Advise patients to avoid co-administration of VUMERITY with alcohol [see Dosage and Administration (2.2)]. Anaphylaxis and Angioedema Advise patients to discontinue VUMERITY and seek medical care if they develop signs and symptoms of anaphylaxis or angioedema [see Warnings and Precautions (5.1)].
Progressive Multifocal Leukoencephalopathy Inform patients that progressive multifocal leukoencephalopathy (PML) has occured in patients who received dimethyl fumarate, and therefore may occur with VUMERITY. Inform the patient that PML is characterized by a progression of deficits and usually leads to death or severe disability over weeks or months. Inform the patient of the importance of contacting their healthcare provider if they develop any symptoms suggestive of PML. Inform the patient that typical symptoms Data associated with PML are diverse, progress over days to weeks, and Animal Data include progressive weakness on one side of the body or clumsiness Oral administration of diroximel fumarate (0, 40, 100, or 400 mg/kg/ of limbs, disturbance of vision, and changes in thinking, memory, day) to pregnant rats throughout organogenesis resulted in a decrease and orientation leading to confusion and personality changes [see in fetal body weight and an increase in fetal skeletal variations at the Warnings and Precautions (5.2)]. highest dose tested, which was associated with maternal toxicity. Plasma exposures (AUC) for MMF and HES (the major circulating drug- Herpes Zoster and Other Serious Opportunistic Infections related compound in humans) at the no-effect dose (100 mg/kg/day) Inform patients that herpes zoster and other serious opportunistic for adverse effects on embryofetal development were approximately infections have occurred in patients who received dimethyl fumarate 2 times those in humans at the recommended human dose (RHD) of and therefore may occur with VUMERITY. Instruct the patient of the importance of contacting their doctor if they develop any signs or 924 mg/day. Oral administration of diroximel fumarate (0, 50, 150, or 350 mg/kg/ symptoms associated with herpes zoster or other serious opportunistic day) to pregnant rabbits throughout organogenesis resulted in an infections [see Warnings and Precautions (5.3)]. increase in fetal skeletal malformations at the mid and high doses and Lymphocyte Counts reduced fetal body weight and increases in embryofetal death and Inform patients that VUMERITY may decrease lymphocyte counts. A fetal skeletal variations at the highest dose tested. The high dose was blood test should be obtained before they start therapy. Blood tests are associated with maternal toxicity. Plasma exposures (AUC) for MMF also recommended after 6 months of treatment, every 6 to 12 months and HES at the no-effect dose (50 mg/kg/day) for adverse effects on thereafter, and as clinically indicated [see Warnings and Precautions embryofetal development were similar to (MMF) or less than (HES) (5.4) and Adverse Reactions (6.1)]. those in humans at the RHD. Oral administration of diroximel fumarate (0, 40, 100, or 400 mg/kg/day) Liver Injury to rats throughout gestation and lactation resulted in reduced weight, Inform patients that VUMERITY may cause liver injury. Instruct which persisted into adulthood, and adverse effects on neurobehavioral patients treated with VUMERITY to report promptly to their healthcare function in offspring at the highest dose tested. Plasma exposures provider any symptoms that may indicate liver injury, including fatigue, (AUC) for MMF and HES at the no-effect dose for adverse effects on anorexia, right upper abdominal discomfort, dark urine, or jaundice. A postnatal development (100 mg/kg/day) were approximately 3 times blood test should be obtained before patients start therapy and during treatment, as clinically indicated [see Warnings and Precautions (5.5)]. (MMF) or similar to (HES) those in humans at the RHD. 8.2 Lactation Risk Summary There are no data on the presence of diroximel fumarate or metabolites (MMF, HES) in human milk. The effects on the breastfed infant and on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for VUMERITY and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition. 8.4 Pediatric Use Safety and effectiveness established.
in
pediatric
patients
have
not
Flushing and Gastrointestinal (GI) Reactions Flushing and GI reactions (abdominal pain, diarrhea, and nausea) are the most common reactions, especially at the initiation of therapy, and may decrease over time. Advise patients to contact their healthcare provider if they experience persistent and/or severe flushing or GI reactions. Advise patients experiencing flushing that taking VUMERITY with food (avoid high-fat, high-calorie meal or snack) or taking a nonenteric coated aspirin prior to taking VUMERITY may help [see Dosage and Administration (2.2) and Adverse Reactions (6.1)].
Pregnancy been Instruct patients that if they are pregnant or plan to become pregnant while taking VUMERITY they should inform their healthcare provider [see Use in Specific Populations (8.1)].
8.5 Geriatric Use Clinical studies of dimethyl fumarate and VUMERITY did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently from younger patients. 8.6 Renal Impairment No dosage adjustment is necessary in patients with mild renal impairment. Because of an increase in the exposure of a major metabolite [2-hydroxyethyl succinimide (HES)], use of VUMERITY is not recommended in patients with moderate or severe renal impairment [see Clinical Pharmacology (12.3)].
Manufactured for: Biogen Inc. Cambridge, MA 02142 VUMERITY is a registered trademark of Biogen. © Biogen 2021
AMERICAN BRAIN FOUNDATION Celebrate Breakthroughs in Brain Disease Research at April 6 Commitment to Cures Gala Join us on April 6 at the AAN Annual Meeting in Seattle for Commitment to Cures, the annual gala that galvanizes the neurology community around the crucial need to support research. Don’t miss out on listening to extraordinary stories from people living with brain disease, important updates on our latest research studies, and special guests, including actor and comedian Seth Rogen and his wife, Lauren Miller Rogen. The event will also feature Susannah Cahalan, the New York Times bestselling author of Brain on Fire, and Dr. Stephen L. Hauser, who will be honored for his career-long commitment to understanding multiple sclerosis. The event will begin with a cocktail reception at 6:00 p.m. PT followed by a seated dinner and program. Unable to attend in person? Join us virtually!
Public Leadership in Neurology Award Recipients Seth Rogen & Lauren Miller Rogen
Scientific Breakthrough Award Stephen L. Hauser, MD
Ambassador Award Recipient Susannah Cahalan
Get your ticket when you register for the AAN Annual Meeting or at AmericanBrainFoundation.org/C2C2022. All ticket sales and proceeds go to funding brain research.
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Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added. Neurologist—Assistant/Associate Professor UVM Health Network—Central Vermont Medical Center—Vermont, Four Seasons of Outdoor Activities at Your Doorstep! The Robert Larner, M.D. College of Medicine at the University of Vermont (UVM) and the University of Vermont Medical Center (UVMMC) seek to recruit a physician to join our established program in General/Comprehensive Neurology. The successful applicant will be involved in a primarily clinical care role at University of Vermont Health Network – Central Vermont Medical Center (CMVC) in Berlin, Vermont. This position offers the unique opportunity to work in a community setting while still being involved with an academic center. Located in the heart of the Green Mountain state, CVMC has a reputation for clinical excellence with a staff deeply rooted in our community. The general neurology practice sees a wide variety of neurologic conditions, including epilepsy/ seizure disorders, stroke, chronic headaches/ migraines, multiple sclerosis, Parkinson’s and Alzheimer disease, as well as movement and neuromuscular disorders. The ideal candidate will be skilled in reading EEGs and/or conducting/ interpreting EMGs. This is a full-time, 12 month, salaried position with attending staff privileges at CVMC. All applicants must be American Board of Psychiatry and Neurology board eligible/certified. Fellowship training in a clinical neurology discipline is desired, however not a requirement. Our goal is to continue the high level of clinical care and education currently provided as we develop our clinically integrated network. The Central Vermont Medical Center site is evolving as a graduate medical education site and opportunities for teaching will be supported. UVM is especially interested in
candidates who can contribute to the diversity and excellence of the academic community through their research, teaching, and/or service. Applicants are requested to include in their cover letter information about how they will further this goal. UVM and UVM Medical Center are Equal Opportunity/ Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category legally protected by federal or state law. The University encourages applications from all individuals who will contribute to the diversity and excellence of the institution. The application receipt and review process will begin immediately and continue until the position is filled. Interested individuals should apply online for position #45098 at www.uvmjobs.com. For more information, contact Sarah Child at Sarah.Child@CVMC.org or phone (802) 225-1739. For more information regarding the Department of Neurological Sciences, please see our website at http://www.uvm.edu/ medicine/neuro/
team, Physician focused administration, Neuro-Hospitalist, 7 on 7 off block schedule, Covering only 1 hospital, 24 hour Tele-stroke support, Outpatient Neurology, Join an established, experienced and well-respected outpatient Neurology group of 3 physicians, No call and no weekends, Growing market with a strong referral base, Excellent Financial Package: Competitive salary, Bonus Incentive available and Excellent benefit package. Email Monica Young at youngmon@sjchs.org with interest or for more information.
Unique opportunities that offer an affiliation between Augusta University and St. Joseph's/Candler—St. Joseph's Candler Physician Network—Savannah is known for it's spectacular architecture, beautiful historic district and city squares
he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.
Neuro-Hospitalist and Outpatient Neurologist needed for unique opportunities that offer an affiliation between Augusta University and St. Joseph’s/Candler Physician Network. Highlights of the opportunities are: Facility is a not-for-profit faith based institution, Employed position with Augusta University, Faculty appointment, Excellent support
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he AAN offers a complete package of print, T online, and in-person recruitment advertising opportunities. Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the May 2022 print edition of AANnews A must be submitted by April 1, 2022. The same deadline applies to changes/cancellations.
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