Multiple sclerosis has challenged the medical research community since it was first identified. Case in point: advances in MS treatment were the focus of a recent international conference known as ECTRIMS (European Committee for Treatment and Research in MS). The conference included hundreds of research presentations on currently approved medications and approaches to MS therapy.
Although the research results presented were preliminary and thus not absolutely definitive—most of the studies had not yet been reviewed for formal publication in medical journals – they nevertheless point to promising progress in MS treatment. Among the most interesting research findings:
Interferon Treatment and Glatiramer Acetate
The four most commonly used MS medications are glatiramer acetate (Copaxone) and interferons (Avonex, Betaseron, Rebif). Some general issues about these medications have not yet been resolved and are under active investigation.
Switching Medications
One research presentation focused on how people who are not doing well on one of these medications respond if they are switched to another medication. For example, if people are having attacks on an interferon, how will they do if they are switched to Copaxone? Or, if people are not doing well on Copaxone, will they benefit from switching to an interferon? This study found that people who had attacks on one medication experienced fewer attacks when switched to another medication.
Comparing Medications
Two studies evaluated the effectiveness of Copaxone in comparison to interferon treatment. One of these studies, known as BECOME, compared Copaxone with Betaseron. It was reported that these two medications had similar effects on MRI lesions and also on attacks, disability, and cognitive function.
Another study, known as REGARD, compared Copaxone with Rebif, and found that there was no difference in the amount of time before people experienced an attack. The REGARD study results were complicated by the fact that, overall, study participants had significantly fewer attacks than was expected.
Adherence
A significant issue with MS medications, as well as other injectable medications, is making sure that people are actually taking the medications—this is known as “adherence.” One study reported that adherence was improved in those who were female, were satisfied with their treatment, discussed adherence with their neurologist at the time of starting treatment, and had good family support. Another study found that adherence was higher in those who were older and believed that they were well informed about MS and MS treatment.
New Formulations of Current Drugs
Two studies reported on new preparations of interferons. One of these studies found that a double dose of Betaseron did not provide any additional benefit over the current dosing. Several studies evaluated a new preparation of Rebif and found that, relative to the current Rebif preparation, it was less likely to cause reactions at injection sites and less likely to cause the body make possibly harmful antibodies against the drug. This new formulation of Rebif is currently available in some European countries and is expected to be available in the United States in the next several months.
Combinations of Drugs
A “new wave” in MS treatment is “combination therapy,” which involves combining two or more potentially beneficial MS medications. This strategy has been used for years for other medical problems, such as high blood pressure and infections.
One type of study in this area involves combining one of the injectable medications with cholesterol medications known as “statins.” (Statins include medications such as Zocor and Mevacor.) The story of statins in MS has been a “roller-coaster ride.” Initially, there was limited evidence that statins had beneficial effects in the animal model of MS and in people with MS.
Subsequently, there was concern that statins might decrease the effectiveness of interferon treatment. Now, as of the most recent MS meetings, there are several studies that indicate that statins do not inhibit the beneficial effects of interferons. All of this work is still preliminary, so there may be additional “ups and downs” as studies are reported in this area. “Stay tuned” as more information becomes available—in the meantime, those who take statins should discuss the used of these medications with their physicians.
Induction therapy
A specific type of combination therapy that is currently under investigation is known as “induction therapy.” With this type of treatment, a high dose of chemotherapy is given to quickly and significantly decrease immune system activity—after this initial treatment, the chemotherapy is discontinued and more moderate (and less toxic) therapies, such as interferons or Copaxone, are used to try to maintain the immune system activity at this lower level.
At the recent MS conference, there was a report that people who were treated with chemotherapy (mitoxantrone or Novantrone) and Betaseron did better than those treated with Betaseron alone. There are many other ongoing studies of this exciting new treatment approach.
Natalizumab (Tysabri)
The most recently approved MS medication is natilizumab (Tysabri). This medication appears to have notable beneficial effects, but it also increases the risk of a severe, usually fatal brain infection known as PML (progressive multifocal leukoencephalopathy). At the recent MS conference, there were several encouraging reports related to Tysabri.
First, it was reported that more than 26,000 people worldwide have been treated with Tysabri and, through an intensive Tysabri monitoring process, no new cases of PML have been identified. In addition, a small study found that if a person developed PML, a treatment known as “plasma exchange” or “plasmapheresis” may be an effective way of removing Tysabri from the blood.
References
More information about the research studies reported at the ECTRIMS meeting may be found at: www.akm.ch/ectrims2007/.
See Related Articles
Discover how doctors may prescribe customized treatments for MS patients individually, in MS Treatment of the Future Will Be Determined by Genes.
See MS Treatment: Advances in MS Therapy for more information about currently approved Multiple Sclerosis (MS) medications and therapies.
