Just two decades ago, there was no available treatment for multiple sclerosis. Over time, driven by the accumulated suffering of millions of patients and their families, medical research has gained momentum, leading to the emergence of innovative therapies.
Multiple sclerosis (MS) is a potentially disabling disease that affects the brain and spinal cord, with approximately 2.1 million individuals worldwide living with the condition.
The precise factors causing and perpetuating MS are not fully understood. It is an autoimmune disease attacking the myelin sheath, the protective layer around nerves facilitating the travel of electrical signals within the brain and between the brain and the rest of the body through the spinal cord.
As time progresses, MS can permanently damage nerve fibers in the brain and spinal cord. Symptoms vary depending on the affected nerves and the extent of damage. Loss of vision, initially temporary and later permanent, numbness and weakness in any part of the body, walking difficulties, staggering gait, and tremors are some common symptoms. If you experience these symptoms suddenly, visit in person or check the website www.topneurologistdubai.com.
Recent Medications Approved by the U.S. Food and Drug Administration (FDA):
Currently, disease-modifying therapies (DMTs) represent the best strategy to slow down the course of MS. DMTs reduce the frequency and severity of relapses, development of new lesions, and progression of disability.
The number of available DMTs has rapidly increased, with at least 15 of them approved by the FDA for relapsing forms of MS, including relapsing-remitting MS (RRMS). One of these has also been approved for use in primary progressive MS (PPMS), and another has received FDA approval for use in secondary progressive MS (SPMS).
Ocrelizumab
In 2017, the FDA granted approval to a groundbreaking new drug for treating remitting-relapsing MS (RRMS), marking the first approval for primary progressive MS (PPMS) as well. Extensive research conducted by a team of scientists has demonstrated that ocrelizumab significantly reduces relapses in RRMS and decelerates the progression of symptoms in PPMS.
Ocrelizumab, like many other MS treatments, is an immunosuppressant drug. While most MS drugs target T cells, ocrelizumab focuses on a specific subset of B cells believed to contribute to the destruction of myelin. Phase III clinical trials for RRMS revealed that compared to interferon beta-1a, ocrelizumab could decrease relapse rates by up to 47 percent, reduce disability by up to 43 percent, and minimize inflammatory lesions in the brain by 95 percent. Patients receiving ocrelizumab not only experienced fewer new brain lesions but also exhibited less loss of brain volume than the placebo group.
Latest Advancements in the MS Drug Pipeline:
The journey from the test tube to the pharmacy shelf for new medicines typically spans 10 to 15 years. Out of every 10,000 compounds tested, only one or two usually become licensed treatments, with many rejected due to safety concerns, quality issues, or lack of efficacy. Some therapies currently in the final phase of clinical trials are listed below. Successful completion of this phase leads to data from phases I through III being submitted to the FDA for approval. Following FDA approval, only 25 to 30 percent of drugs progress to the subsequent stage in the development process.
Laquinimod
Laquinimod, currently in phase III trials for relapsing RRMS and phase II trials for PPMS, is an experimental drug that may impede immune cells from reaching the brain. Investigations suggest that Laquinimod possesses both anti-inflammatory and neuroprotective actions. Phase III studies have demonstrated a 23 percent reduction in the annual relapse rate compared to a placebo, a 33 percent decrease in disability progression, and a 44 percent reduction in brain volume loss.
Autologous Hematopoietic Stem Cell Transplantation (AHSCT) aims to "reboot" the immune system in individuals with MS. Hematopoietic stem cells, derived from the person's own blood or bone marrow, are collected and stored. Following the depletion of much of the immune system using chemotherapy drugs, the stored stem cells are reintroduced to the body. Over 3 to 6 months, the new cells make their way to the bone marrow, gradually rebuilding the immune system.
Imperial College London recently published the long-term outcomes of AHSCT in individuals with relapsing MS. The findings indicate that AHSCT may halt the progression of symptoms for 5 years in 46 percent of MS patients. However, the treatment involves significant risks due to the use of aggressive chemotherapy.
MD1003
In phase III trials for primary and secondary progressive MS, MD1003 (high-dose biotin) is undergoing testing. This drug, a significantly concentrated form of biotin at 10,000 times the recommended daily intake, activates enzymes related to cell growth and myelin production. The administration of high doses of biotin is believed to support myelin repair. Researchers conducted a comparison between MD1003 and a placebo in individuals with primary and secondary progressive MS. The results showed that 13 percent of those in the MD1003 group experienced an improvement in disability after 9 months, whereas there was no improvement in the placebo group.
Siponimod
Siponimod is currently in development for use in Secondary Progressive MS (SPMS). This medication operates by containing T cells and B cells within the body's lymph nodes and spleen, preventing their entry into the brain and spinal cord and averting damage to the myelin sheath of nerve fibers. In a phase III trial, siponimod demonstrated a 21 percent reduction in the risk of disability progression at 3 months of treatment and a 26 percent reduction at 6 months compared to a placebo. The drug also exhibited effectiveness in reducing the number of relapses and preventing brain shrinkage, or atrophy.
Antioxidant
Researchers from the Oregon Health & Science University in Portland suggest that an over-the-counter antioxidant known as lipoic acid could be beneficial in treating Secondary Progressive MS (SPMS). Their study indicated a 68 percent improvement in slowing the rate of whole brain atrophy with lipoic acid compared to a placebo. In comparison, the recently approved ocrelizumab demonstrated an 18 percent improvement over placebo in slowing the rate of whole brain atrophy in primary progressive forms of MS.