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:
- Reduce the number of new MS attacks, called relapses
- Delay disability
- Limit new inflammation in your central nervous system (CNS)
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 has been approved 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).
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 get it only 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 researchers 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.
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.
Biomarkers: These are signs from your body fluids or imaging (like MRI) that help you and your doctors keep track of the progression of your disease so that you can treat it most effectively. For example, a simple new blood test that measures small amounts of neuron-derived proteins (neurofilaments) may be used to predict how serious your MS will be and how well your treatment will protect brain tissue. Scientists continue to study known biomarkers for more information and to look for new ones.
Genes: These make up the biological instruction manual from your parents on how to build and maintain your body. There are genes known as "susceptibility genes” that seem to raise your risk for MS. Scientists are studying how these genes work in the nervous system in order to learn more about how they could lead to MS. This includes studies about the way genes that underlie gender affect MS.
Environment: Certain things that happen in your environment, like a lack of vitamin D or exposure to the Epstein-Barr virus, may affect the likelihood of you getting MS. Scientists continue to study this and to look for other factors.
Gut microbiome: This is the natural balance of bacteria in your gut. The nature of this microbiome seems to change with MS. Scientists are studying whether it may be possible to change the microbiome with specialized probiotics to help lessen or prevent the development of MS in some people.
Immune system: Your body’s immune response has long been known to play a part in MS. Scientists continue to study the specifics of this process, including how B cells, T cells, dendritic cells, and natural killer cells work in the disease. This has already led to some treatments and may lead to more.
Imaging: Pictures of your brain and spinal cord (neuroimaging) can help better diagnose MS, as well as track disease progression and treatment. In addition, scientists collect imaging of the brain, spinal cord, and parts of the eye (retina) to look for changes in the course of MS over time. In this way, they hope to learn more about how the disease works as well as the positive and negative effects of different treatments. Scientists continue to look for more powerful and accurate imaging to track MS, especially in the development of new MRI, or magnetic resonance imaging, machines.