Multiple Sclerosis Treatment
1 AnswerThe efficacy of cannabinoids for the treatment of multiple sclerosis (MS)-related pain is also a controversial topic. In clinical trials, some patients treated with cannabinoids had improvements in MS-related pain; however, additional clinical trials are needed before cannabinoids are considered to be first-line therapies. Duloxetine (Cymbalta) and pregabalin (Lyrica) are both approved for diabetic neuropathic pain. Although not specifically approved as a treatment for MS-related pain, many MS neurologists consider these products to be good treatment options for MS-related pain.
1 AnswerBetaseron is a type of protein called beta interferon that occurs naturally in the body. It is used to treat relapsing forms of multiple sclerosis (MS). It will not cure your MS but may decrease the number of flare-ups of the disease. MS is a lifelong disease that affects your nervous system by destroying the protective covering (myelin) that surrounds your nerve fibers. The way Betaseron works in MS is not known.
1 AnswerTovaxin, a medication for the treatment of people with secondaryprogressive multiple sclerosis (SPMS) has been granted fast-track designation by the U.S. Food and Drug Administration (FDA). Tovaxin is a personalized cellular immunotherapy treatment that is in late stage clinical development for multiple sclerosis (MS). It is prepared from a sample of the person’s own cells. Myelinreactive Tcells are extracted from the blood and irradiated to produce a vaccine. When injected, the vaccine triggers a potent immune response against specific subsets of autoreactive Tcells known to attack myelin and thereby reduces the risk of relapse over time, according to the drug’s developer, Opexa Therapeutics. “People with progressive forms of multiple sclerosis are faced with no proven effective treatment options, so the fast-track designation for Tovaxin is meaningful as it should enable Tovaxin to move more rapidly through the regulatory process, once it is proven to be efficacious,” commented Mark Freedman, MD, FRCP, FAAN, professor of medicine at the University of Ottawa and director of the Multiple Sclerosis Research Unit at the Ottawa Hospital. “Novel therapies such as Tovaxin offer hope for people with a diagnosis of progressive MS.”
Opexa reports it is planning to initiate a phase IIb clinical trial with Tovaxin in SPMS subject to securing the necessary resources, while remaining committed to further advancing Tovaxin in relapse-remitting MS (RRMS) at a later date.
Says Multiple Sclerosis Foundation Senior Medical Advisor Ben Thrower, MD, “Tovaxin is exciting in that it could be a truly ‘customized’ therapy for people with SPMS. This vaccine is made from the person’s own Tcells and can be repeated over time to account for any changes in the underlying immune attack on myelin. We know that how MS works may vary immunologically from one person to the next. Having a therapy that is unique to that person’s MS would represent a major step forwards.”
1 AnswerA Phase III trial of alemtuzumab (Lemtrada for relapsingremitting MS (RRMS) reduced relapse rates by 49% and dropped the risk of sustained worsening of disabilities by 42% in participants. Known as CARE - MS2, it was the second of two phase III trials. In this study, the drug was tested in a headtohead trial against Rebif. The maker of the drug, Genzyme, says it plans to file for FDA approval of the drug, also noting that it has been granted “fast-track” status.
According to the U.S. Food and Drug Administration (FDA), products with a fast-track designation often receive priority review, which may offer a significant benefit in that, historically, the review time of a priority product is almost half that of a standard review. Additionally, fast-track priority review products are more likely to be approved on the first review cycle than those without the designation. Alemtuzumab is an antibody that works by targeting a protein on cell surfaces called CD52. Genzyme’s research suggests that the drug depletes the T and B cells believed to be responsible for cell damage in MS.
1 AnswerMultiple sclerosis (MS) is a multifactorial disease, meaning that it can create many symptoms. Therefore, you should ideally have a team of specialists to address all the individual factors that your disease entails. This not only includes a neurologist specializing in MS, but also an internist who is familiar with the disease, a physical and occupational therapist to deal with mobility issues, and a speech language pathologist to assist with speech and swallowing issues. Depending on the specifics of your MS you may also need a urologist, a gynecologist, a psychiatrist, a social worker and an orthopedist. These people should be chosen with specific consideration of their knowledge of MS.
1 AnswerChoosing a therapy for multiple sclerosis (MS) is often guided by experience (although an appropriate risk/benefit analysis should be undertaken), and subsequently, the response to therapy is assessed. People often have breakthrough disease on the chosen agent, necessitating a treatment change. In fact, every medication switch trial that has ever been done has been positive. Having to switch treatments because of suboptimal response is not only inconvenient, but it also may result in unnecessary loss of brain tissue or irreversible disability. MS clinicians sometimes initially chose a secondline therapy based on certain individuals’ characteristics, including severe, multifocal attack, lack of recovery after an early relapse or a high burden of disease on magnetic resonance imaging (MRI) at diagnosis.
There is some data to suggest that prospective biomarkers will allow doctors to make better treatment decisions by more accurately predicting the appropriate therapy for the appropriate person at the appropriate time. One of the big questions is whether an anti-inflammatory or a neuroprotective agent (or both) is more appropriate. One of the other big pending research questions is whether a combination of two safer drugs will offer the efficacy of one of the more powerful but relatively less safe drugs.
1 AnswerThere has been positive Phase III data presented for four possible diseasemodifying therapies for multiple sclerosis (MS), and there are several agents that are in the midst of Phase III trials. Some of these (altemuzemab, rituximab/ocrelizumab) seem to raise the efficacy bar to new heights, while others (teriflunomide, daclizumab) offer good efficacy and safety. Diseasemodifying therapies seem to exert their effect by tempering the immune response, but some newer oral medications (BG12 and laquinimod) purport to limit degeneration and may be neuroprotective as well.
Hopefully, there will be progress in the realm of central nervous system (CNS) repair, which may offer hope of reversing multiple sclerosis (MS) disability. There is a molecule early in development that seems to inhibit a signal that halts brain development. Conceptually, this will be a huge advance for people with secondary progressive MS (SPMS), but certainly previous attempts to develop treatments for SPMS have not been successful. There is a lot of excitement about stem cells. Although the research in this area is still very early, there seems to be potential to reduce the inflammatory attack, protect cells against degeneration and perhaps induce remyelination.
1 AnswerSometimes the benefits of disease-modifying drugs (DMDs) is counteracted by potential tolerability side effects that may make someone feel like their multiple sclerosis (MS) symptoms are not improving.
This is why it is important to talk to your neurologist about how your DMD makes you feel and to discuss all your options. If you stop taking your DMD on a regular basis but don’t tell your neurologist, then you may be making tolerability side effects more likely. (For example, flu-like symptoms seem to be worse when you don’t take the beta interferons consistently.) Also, you are not taking advantage of the benefits of fully controlling your MS disease process. If you aren’t having perfect control of your MS from your DMD, don’t despair. Your neurologist is well equipped and trained to help guide you through your options. There is presently no cure for MS, yet all the DMDs are partially effective, and the benefit of staying on your current DMD may outweigh the risks of stopping it or of switching to another DMD. Sometimes, however, your neurologist may work with you on transitioning from one DMD to another.
1 AnswerPeople with multiple sclerosis (MS) who take their disease-modifying drugs (DMDs), as directed, are more likely to have less relapses, less disability and less changes on magnetic resonance imaging (MRI) scans. Recent research has explored the concept of sustained freedom from disease activity. For some people, the DMDs stop clinical relapses, disease progression and MRI activity.
To put it concisely:
- DMDs are not cures.
- DMDs are partially effective.
- DMDs may cause side effects.
- DMDs are not designed to control individual symptoms.
- DMDs may reduce the number of MS relapses.
- DMDs may reduce the severity of MS relapses.
- DMDs may reduce the chances for progression of disability.
- DMDs may prevent new or worsening MRI changes.
- DMDs may prevent brain tissue loss (atrophy).
- DMDs may even lead to sustained freedom from disease activity.
1 AnswerShelley Peterman Schwarz, Neurology, answeredHere are some ways to help you manage your medications for multiple sclerosis (MS):
- Ask your doctor whether generic drugs, which are less expensive than brand-name drugs, may be used to fill your prescription. Ask if the generic drug differs from the brand-name drug in terms of efficacy. Also ask your doctor for booklets or other literature on the use and possible side effects of prescribed drugs.
- If you are receiving drugs from more than one doctor, no one physician will have a complete list of your medications. Avoid scattering your prescriptions among several pharmacies. Instead, pick one that fits your needs and stick to it. That way, a complete record of your prescriptions and drug allergies will be on file in one place, and your pharmacist can easily check that a new prescription does not adversely interact with a medication you are already taking. Also find out if the medication(s) you are taking could have an adverse reaction with any over-the-counter drugs that you use.
- Start a new medication as early in the day as possible. If you have an adverse reaction, it will be easier to reach the doctor.
- Before filling the prescription, get specific dosing instructions for each drug. Clarify with your doctor such phrases as "three times a day" or "every 8 hours." Does this mean you should take the medicine three times between 8 a.m. and bedtime, or does it literally mean every 8 hours?
- If the prescription you get from your doctor looks like Greek to you, you're not far off. Many of the abbreviations used are Latin, stemming from a time when Latin was the international language of medicine. To help you remember what b.i.d., t.i.d, and q.i.d. stand for, think of it this way: b is bi (two); t is tri (three); and q is quad (four).
- If you have trouble removing childproof tops from your medication bottles, ask your pharmacist to replace them with regular covers.
- Be sure to find out what you can and cannot do to make taking your medicine easier.
- If you use a medicine dropper to give liquid medications by mouth, release the liquid slowly into the cheek. Be careful not to point the dropper into the throat, which might force the medication down the windpipe.
- If you have difficulty swallowing a pill or tablet, place it in a teaspoon of applesauce or butter it lightly. The pill will be much easier to swallow.
- Ask your pharmacist the best way to store medications -- a high-humidity bathroom cabinet usually is the worst place to put them.
Find out more about this book:Multiple Sclerosis (300 Tips for Making Life Easier)