MS Treatment Research Roundup

Cutting-edge treatments make it possible to live better with multiple sclerosis (MS) than ever before. Researchers constantly learn more about the disease and come up with new ways to fight it. Discoveries today could pave the way for a cure in the future.

MS can affect you from head to toe. It happens when your immune system goes haywire and attacks nerve cells in your brain and spinal cord. This inflames and damages your nerves’ protective coating, called myelin. That means your nerves can’t message each other as they should. It leads to mental and physical problems, and sometimes disability.

Disease-modifying therapies (DMTs) are drugs used to prevent MS from getting worse. The American Academy of Neurology recommends that people start using a DMT soon after diagnosis to protect their myelin. This can:

What’s New?

The FDA has approved more than a dozen DMTs for MS. New ones are coming out at lightning speed.

The focus of research has shifted in recent years. T cells, a type of cell in your body’s immune system, were long thought to be responsible for MS. But recent studies show that another type of immune cell, called B cells, also play a role in the attack on your myelin. New treatments target these cells.

Ocrelizumab (Ocrevus) kills certain B cells in your blood. It’s approved in the United States for all forms of MS. But it's the first drug used specifically to treat the primary progressive type of MS. The National Multiple Sclerosis Society calls ocrelizumab a "game changer." You get it in an IV every 6 months.

Another drug that targets B cells is waiting for approval by the FDA for relapsing MS, the most common type. Ofatumumab is already used to treat some kinds of leukemia. It’s a shot you give yourself once a month.

Researchers compared ofatumumab to teriflunomide (Aubagio), a daily pill commonly used for MS. The study found that ofatumumab led to 50% fewer relapses. It also cut the risk of disability getting worse by about 30%. And it reduced the number of new MS lesions (scars).

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Other recent treatment highlights include:

  • In 2018, Fingolimod (Gilenya) became the first drug approved to treat relapsing forms of MS in children as young as 10. (It's also used in adults.) Fingolimod is a once-a-day pill. It traps certain white blood cells inside your lymph nodes, glands that help filter out harmful substances in your body. This means the cells can’t get into your central nervous system, which reduces the damage from inflammation.
  • Siponimod (Mayzent) was approved in 2019 as the first oral drug to specifically treat active secondary progressive disease (SPMS with relapses). It’s similar to fingolimod. It also treats clinically isolated syndrome (CIS) and relapsing-remitting disease (RRMS).
  • Ozanimod (Zeposia) won approval in 2020 to treat adults with relapsing types of MS. Like fingolimod and siponimod, it works by keeping some white blood cells out of circulation. You take it as a daily pill.
  • Cladribine (Mavenclad) was approved in 2019. It targets T cells and B cells. It treats relapsing types of MS, including active secondary progressive disease but not CIS. You only get it if you can't take other drugs for MS or when those drugs don’t work. That's because of safety concerns, including a higher risk of cancer and birth defects in unborn children. You take it as a pill in two cycles over 2 years.
  • Diroximel fumarate (Vumerity), approved in 2019, also treats relapsing MS. Researchers think it changes the response of your immune system so it causes less inflammation. It may also help protect your nerve cells from damage. It's similar to another drug called dimethyl fumarate (Tecfidera).

What’s on the Horizon?

MS researchers continue to find new ways to use current drugs.

Ibudilast is a drug used in parts of Asia to treat asthma and some effects of strokes. In a second trial study of this drug, researchers found it slowed brain shrinkage in people with progressive MS. The FDA put ibudilast on a fast track for possible approval once its trials are finished.

One important question researcher have is: How can we repair myelin? Treatments under the microscope include:

  • An antihistamine (a type of drug often used for allergies) called clemastine fumarate (Tavist). It was found to improve nerve signals in people with damage to their optic nerves. This suggests that some myelin was rebuilt.
  • Metformin, a common diabetes drug. In one study in rats, it repaired stem cells that build myelin. The drug mimics the effects of intermittent fasting (eating every other day), which also helped repair myelin in the same rat study.

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Stem cell transplants are another area of research. The National Institutes of Health is paying for a multi-city study to see if they work better than drug treatments for people with severe relapsing MS. Previous studies show they can work.

Here’s how it’s being tested: Half the people get the best available drugs that could improve their MS. The other half get what’s called an autologous hematopoietic stem cell transplant. The stem cells are taken from your own bone marrow and frozen. Next, doctors give you chemotherapy to kill the immune cells that cause MS. Finally, the bone marrow stem cells are infused back into you.

The hope is that the transplanted stem cells flood your immune system, reset it, and stop the attack on your myelin. It could keep the disease from getting worse, mean you don’t need lifelong MS medications, and possibly bring back some physical abilities.

Stem cell transplants are risky. So it’s important to find out if the benefits outweigh the risks, when compared with medicines that also can have side effects.

WebMD Medical Reference Reviewed by Christopher Melinosky on August 18, 2020

Sources

SOURCES:

National Multiple Sclerosis Society: "Definition of MS," "Medications," "Research Finds That Immune B Cells from People with MS May Harm Nerve Cells," "FDA Approves Ocrevus (ocrelizumab) for People with Primary Progressive MS or Relapsing MS -- First Disease-Modifying Therapy for Primary Progressive MS,"  " Results Published from Phase 3 Clinical Trials of Ofatumumab in Relapsing MS," "FDA Expands Use of Gilenya (fingolimod) for Children and Teens 10 Years and Older with Relapsing MS -- First Approved Therapy for Pediatric MS," "FDA Approves Siponimod -- Brand named Mayzent -- for Relapsing Forms of MS Including Active Secondary Progressive MS UPDATE,"  "Mavenclad," "Phase 2 Clinical Trial of Oral Ibudilast Demonstrates Slowing of Brain Atrophy in Progressive MS," "Restoring What’s Been Lost," "FDA-Approved Oral Zeposia (Ozanimod) for Relapsing Forms of MS Now Available for Prescription," "FDA Approves Oral Vumerity (Diroximel Fumarate), Similar to Tecfidera, for Relapsing MS."

News releases, National Multiple Sclerosis Society.

Multiple Sclerosis Trust: "Ofatumumab."

Novartis: "Novartis receives FDA approval for Mayzent (siponimod), the first oral drug to treat secondary progressive MS with active disease."

American Academy of Neurology: "Over-The-Counter Drug May Reverse Chronic Vision Damage Caused By Multiple Sclerosis."

MS Society UK: "Diabetes drug metformin promotes myelin repair in rats."

National Institutes of Health: "New multiple sclerosis treatment trial compares stem cell transplantation to best available drugs."

Immune Tolerance Network: "About BEAT-MS."

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