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September 28, 2009

Pushing ahead with multiple sclerosis therapies

Posted: 12:43 PM ET

By Georgiann Caruso
CNN Medical  Associate Producer

When I first heard about the possibility of a pill for multiple sclerosis (MS), I exlaimed, "No way!" As a person living with MS, I know that this would be a enormous advance for the MS community. The option of a pill instead of needles sounds incredible, making it so much easier for many people to stay on their therapies since currently they all involve needles. Delving into this further, I realized that several drugs in trials seemed to hold great promise, and they are not light years off.

But things aren't as simple as they first appeared.

First off, an explainer for those unfamiliar with the disease who might be curious, because chances are you know someone affected by MS. The National Multiple Sclerosis Society defines it as a "chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves." The cause isn't yet known and there is no cure. What happens is the myelin - the covering of the nerves - is destroyed by the immune system. The result is scar tissue; therefore nerve impulses, or messages, are slowed down leaving people with any number of symptoms including balance, speech, vision and memory problems as well as fatigue and heat sensitivity, to name a few.

Currently, there are five potential first-line disease-modifying therapies on the market, which became available starting in the early 1990s. Four are injectibles, and vary from being given once a day to once a week. Then a few years ago, the drug Tysabri was introduced, offering a new option for people with MS as it is given intravenously once every four weeks. The choice is up to the patient and the provider.

The drugs are intended to reduce the frequency and severity of MS attacks and slow the progression of the disease. Depending on the therapy, clinical relapses can be reduced by between 1/3 and 2/3.

But the FDA has yet to approve a therapy that can be taken orally. That may soon change.

Scientists from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) just wrapped up a meeting in Düsseldorf, Germany where they discussed this and other exciting developments in the MS community. So what does this mean for the more than 400,000 people in the U.S. - and the more than two million people worldwide –that have this debilitating neurological condition? And what does it mean for their families, friends and caregivers?

I posed that question to Dr. John Richert, Executive VP, Research & Clinical Programs of the National Multiple Sclerosis Society, who emphasized that this is a very exciting time in the MS community.

He brought back news of the emerging trends discussed at the conference:

- The first oral symptom-management drug designed to improve nerve conduction, Fampridine, is already before the FDA for review. Fampridine has been shown to improve walking speed, but may also prove to help with other symptoms of the disease (which are less easy to quantify.) Expected to follow soon are the oral disease-modifying therapies Cladribine and Fingolimod. It's important to note though, these new drugs may well carry different risks than some of the currently available options. So while the method of taking them may be easier, they will not come without their own set of possible side effects and, as Richert suggests, there will be some unchartered territory as more people take the drugs.

-Therapies with infrequent dosing (such as once a year) are being studied.

-Stem cells hold promise for new MS treatments. Of particular interest are adult bone marrow mesenchymal stem cells. According to Richert, it's a bit too early yet to know whether this approach will prove safe and beneficial, or how exactly the therapy will work.

-Within the next year or two, most of the common genes that predispose people to develop the disease will be identified. This is important not only for prevention, but for treatment as well. However, further research is needed about environmental triggers to see how genes and the environment interact to cause MS.

MS is a complicated disease and varies among individuals. What is your realistic hope for the disease and research? Now or 5-10 years down the road? We'd like to hear from you.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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Filed under: Autoimmune disorder • Health


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Diane P.   September 28th, 2009 7:49 pm ET

Thank you for giving me the opportunity to say that I am thrilled about the future of MS therapies., especially the oral medicines. I have been on a once a week shot for a long time and would gladly give it up.

tyrell rose   September 29th, 2009 11:57 am ET

This is a very exciting article and i hope to see many more related to it in the future. My mother has MS and was taking shots for a couple years but doesn't like needles so this is a huge step in the medical field and hope it works out soon!!

Dennis   September 29th, 2009 6:19 pm ET

My wife was diagnosed with MS by "modern medicine" in 1995. The diagnosis was wrong however, even though the symptoms are the same, even the lesions on the brain. My wife was later identified as having Lyme disease, not MS, by a microbiologist. The standard lyme test is less than 40% accurate and when the test comes back negative the doctor ends up diagnosing the patient with a disease based on the symptoms at that time, such as MS, Crohns, chronic fatigue, fibromyalgia, rheumatoid arthritis, Epstein Barre, Parkinson, Lupus, Irritable Bowel, juvenile rheumatoid arthritis, etc. The only way to get an accurate test is to go to a lyme-literate doctor, who would send your test to the diagnostic lab in California known for accuracy. For more information go to: http://www.samento.com.ec/sciencelib/sammain.html
My wife is doing well and is a professor at the local university. Don't give up and do your own research. It can save a life.

Shari   September 30th, 2009 12:43 am ET

So very pleased to hear of the great MS research which continues in the attempt to stave off this horrible disease. I have MS & do not have health insurance. No one will insure me – I have been told that I am an automatic decline of policy. Please pray that reasonable health care reform goes through in the U.S. this year. It is a matter of life & death for me. Thanks

Pam in Oregon   October 5th, 2009 1:58 am ET

My step father had MS for over 32 years. Our family would have been grateful to have an oral medication to minimize the effects of MS. It was tough on everyone, especially my mother. Let's hope that FDA finds this oral drug safe in specific uses and dosage so that the impact on families and patients will be reduced.

Pam in Oregon

Erik in Colorado   October 10th, 2009 9:10 pm ET

I was diagnosed with MS last year at 41 years old. I started noticing "changes" that moved me to get an MRI the fall of 2007 however after discussing the findings with my neurologist he told me that according to my MRI I have had this disease 15 maybe even 20 years due to all the damage seen to my brain as shown by my MRI. Makes sense considering I noticed one pupil larger than the other around the age of 27 and an increasing problem with depression over the years. Finally at work one day I just fell over for no apparent reason and a few days later I woke up feeling very dizzy which hasn't left me since. I now have profound fatigue, dizziness/balance problems and numbness and tingling in my hands. All of this pushed me to get an MRI and never would have guessed that I had MS. I didn't even know what MS was. I thought it was some disease like Parkinson's or Muscular Dystrophy.

I have since my diagnosis been on Rebif and now Copaxone. Rebif landed me in the hospital. The ER doc thought I had sepsis and called a sepsis alert and the chaplain came down! My girlfriend, kids, ex-wife and sister were freaking out. No I didn't have sepsis but I had a violent reaction to Rebif. Copaxone has been great other than the injection site reactions. I don't know if its helping but it doesn't make me sick. However I hate needles and I have forgot to take my daily injection in the past so I would love and oral medication.

Erik

BETTY SCHRAM   October 19th, 2009 3:35 am ET

I HAVE BEEN DIAGNOSED WITH MS SINCE 1992. I AM STILL MOBILE, BUT DO A LOT OF SUFFERING. I TRIED ONE OF THE MEDICINES, BUT OF COURSE IT HAD TO MANY SIDE AFFECTS AND I GOT TO THE POINT WHERE I COULDN'T GIVE MYSELF THE INJECTIONS ANYMORE. MY SON HAS ALSO BEEN DIAGNOSED WITH MS. HE TAKES INJECTIONS, BUT WOULD LOVE TO GET OFF FROM THEM. THE ORAL PILL WOULD BE GREAT FOR HIM. I THINK I AM TO OLD NOW AND PROBABLY WOULDN'T HELP ME, BUT I CERTAINLY HOPE THIS PILL COMES OUT IN TIME TO HELP HIM SO IT WON'T PROGRESS. HE HAS A FAMILY AND LUCKILY HE IS STILL ABLE TO WORK AND HE IS NOT SURE HOW LONG HE WILL BE ABLE TO TAKE THE INJECTIONS. I KNOW A LOT OF MS PEOPLE THAT WOULD LOVE THIS.

Ken Higgins   October 27th, 2009 1:43 am ET

Diagnosed in 1995, I've run the gambit of the injectable meds for MS finally settling in with Avonex. I still get the flu like symptoms the day after injection. The one thing I've learned about MS is that there is nothing "classic" about this disease. Symptoms differ from patient to patient, and sometimes within the same patient. The idea of an oral form would be a great advancement provided the risk to benefit ratio is favorable.

We need to continue to support our MS Associations so that maybe we can reduce or even eliminate this devastating disease.

Shawn in CO   November 12th, 2009 12:41 pm ET

Like Dennis (above), I too have been diagnosed with MS since the young age of 19. I was tested for Lyme... and since the test is about 35% accurate, and I present with symptoms of MS and lesions that present the "classic" picture of it. I took Avonex injections for years and went from having 6 brain lesions to 19+ lesions on my follow-up MRI. It wasn't until I couldn't walk and was dragging my leg that I started to see MDs who all blamed this on "my MS." Well, 40+ doctors later (even Mayo Clinic) I finally went to see a Lyme disease literate doctor who diagnosed me with Lyme and who stated that NOT ONE single "MS patient" of his did NOT present a positive Lyme disease test result once they sent the proper test (Western Blot) to a proper lab. I was treated with IV antibiotics for a year and I am doing better and better. I wish the best to all living with MS, and I know it can be difficult to fathom that it could be a completely different illness, but all I can say is that Lyme is treatable and has a clear cause. Lyme MDs postulate that perhaps Lyme bacteria CAUSES MS as well as a number of other illness that at this time have unknown origins. Please educate yourselves and come to your own conclusions. My life is much better since I have been treating the right illness. I am not so scared of the unknown, either.
best wishes

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Get a behind-the-scenes look at the latest stories from CNN's chief medical correspondent, Dr. Sanjay Gupta, and the CNN Medical Unit producers. They'll share news and views on health and medical trends -- info that will help you take better care of yourself and the people you love.

Editor's Note

Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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