Only a few decades ago, doctors giving a diagnosis of multiple sclerosis had nothing to offer in terms of treatment or support. There's a brighter future for MS patients these days.
Multiple sclerosis, or MS, was first identified in the 19th century. For much of its history, there has been little understanding of how it progresses or how it could be treated.
Although what triggers MS is still unknown, we now understand that it's an immune system disease which attacks the central nervous system.
Neurological “attacks” damage the nerve fibers that help our body communicate with the brain, and symptoms appear in the form of diminishing physical and cognitive function.
It's a tough disease. But research over the past twenty years has sprung a variety of treatments.
Dr. Nicholas LaRocco, vice president of healthcare delivery and policy at the National MS Society, has been working in the field of MS for the past 33 years, and he's seen a dramatic transformation in treatment during that time – and he told dailyRx News that treatments on the horizon are even more exciting.
Where We're Coming From
When Dr. LaRocco started work in the mid 1970s, things were bleak for people with MS. “In the late 1970s and 80s, it was typical practice for physicians to diagnose MS and give very little care beyond that,” he said. “In many cases, they did not communicate very clearly what the diagnosis was.”
There were no FDA approved drugs to alter the course of MS. The best option for patients was to get “comprehensive care” that aimed to improve quality of life with the disease.
With comprehensive care, patients could get help managing their worsening symptoms, the psychological issues that came with a difficult disease, and assistance with employment.
In the meantime, research was beginning to develop drugs. Steroids were used to treat MS attacks by suppressing the immune system.
“A little bit later on, there were immunosuppressant medications to try to treat MS with limited success,” Dr. LaRocco told dailyRx News. These immunosuppressants would act against all activities of the immune system, which is supposed to protect the body against other diseases and infections.
“When you suppress the immune system globally, you're throwing the baby out with the bathwater. It places people in vulnerable positions for certain opportunistic infections,” he said.
In 1993, a milestone came with FDA approval of the first medication designed specifically to treat MS. It was called Betaseron, and targeted the inflammation of lesions formed in the brain during MS attacks.
“For the first time, we had a treatment that was safe and available for treatment of MS,” Dr. LaRocco said. “We had something to try and slow down the progress of the disease.”
Where We Are Now
Dr. LaRocco is still impressed by the advances of treatment in the past decades. “Since [1993], eight additional therapies and three symptomatic treatments have been approved.”
The drug therapies are designed to modify the course of the disease itself. They are supposed to reduce the frequency and severity of attacks, slow the accumulation of damage in the brain and spinal cord, and also slow down the progression of disability.
These medications are an improvement upon the drugs that blasted the immune system. Dr. LaRocco explained, “They're modulating rather than suppressing the immune system.”
Doctors now look at MRIs to monitor lesions in the brain, and focus on improving the patient's ability to live every day life to the best of their ability.
The idea behind the medications is to be selective about what part of the disease process to attack. One approach takes a molecule that binds to a disease-causing element and kill or weaken it, while leaving the rest of the body unscathed. An example of this approach is Tysabri.
Most of the FDA-approved medications must be injected, like Tysabri. The first oral pill approved is Gilenya, taken every day.
But Gilenya was placed under investigation after a patient died soon after starting treatment, earlier this year. All of the medications have notable side effects.
And it's hard for doctors to tell what medications are most effective. “There are certainly individual responses,” said Dr. LaRocco. “A medication that works well with one person may not work with another.”
What's on the Horizon
Doctors and researchers want to personalize medicine, so that there's less trial-and-error finding what works for a patient. “We're not there yet, but it's something that people are really looking into now,” said Dr. LaRocco.
He continued, “One of the important factors may have to do with genetics, perhaps finding that on an individual's genetic makeup one drug might respond better than another.”
In other words, a patient's genetic code might hold clues to what medication will work best for them. Someday, a doctor might be able to match the right treatment to the genes.
A simpler treatment has to do with vitamin D. Studies have found evidence that a lack of vitamin D corresponds to the development of MS.
Historically, MS has been more common in higher latitudes, where people don't get as much vitamin D through the sun. But these days, even people in southern states are getting MS.
Dr. LaRocca, along with others, thinks that it may be because people don't spend as much time outside as they used to. “Studies are looking at vitamin D supplementation, to find out if this can help to slow the course of the disease once people are diagnosed,” Dr. LaRocca told dailyRx News.
“So something as simple as vitamin D is something investigators are looking at as a possible treatment,” he said.
Still, MS does not have one simple answer. Dr. LaRocca calls the next idea “exotic”: Treating MS with intestinal parasites.
Once you get past the "ew" factor, there's a reasonable explanation behind it. Dr. LaRocca explained that if you look at a map of where MS is most common, you'll see that it shows up in industrialized regions like America and Europe much more frequently than less industrialized areas, like Africa and Asia.
The theory goes that there are some “protective factors” as Dr. LaRocca calls them, that may have to do with having lower standards of hygiene. The intestinal parasites that we've cleaned away might actually help protect against MS.
So a possible treatment might be intentionally planting harmless intestinal parasites inside of patients. But back to the realm of more accepted Western medicine: Scientists are also looking to improve upon the treatments they already have.
Tysabri, for example, is what's called a monoclonal antibody. These antibodies bind to specific disease-causing agents in the body and weaken or destroy them.
“Now, the next frontier are known as designer antibodies,” says Dr. LaRocca. Scientists want to shrink down monoclonal antibodies and make them even more specific.
“Their advantage is because of their smaller size, they would be able to bind to targets that current monoclonal antibodies can't, and they would be easier and less expensive,” he explained.
With so much advancement in the treatment of MS, doctors and researchers are hoping to find what Dr. LaRocca calls the “holy grail” - restoration of function. Today, if an attack leaves a patient with trouble walking, they can expect to deal with that symptom for the rest of their lives. Future treatments might be able to bring people back to the level of function they had before the attack.
The idea is that future drugs could tap in to the body's natural ability to restore itself. The human body is capable of restoring some function on its own, but a new drug might be able to make the restorative period longer and stronger.
The other approach is to trick the body into making more myelin – the part of the central nervous system that is damaged during an MS attack. Stem cell research plays a big part in the development of these treatments.
Fortunately for current patients and those diagnosed in the future, research is moving fast.
“Everything we've talked about is a moving target. There are new developments every day, every week,” said Dr. LaRocca.
To keep up to date with new developments, as well as news and information on MS, visit http://www.nationalmssociety.org.
