Therapeutic guidelines for Multiple Sclerosis. Part 2

General description

Pharmacological treatments for Multiple Sclerosis have evolved a lot in the past 20 years. Until 1995 there were no specific treatments, only corticosteroids to control inflammation when the patient suffered outbreaks. However, throughout these two decades MS became the disease within the area of Neurology, in which the most therapeutic advances have been produced due to its high connotation. Thanks to the collaboration of many experts in this entity who are committed to research and supported by the pharmaceutical industry, today we have several options for modifying the course of the disease.

Aside from pharmacological therapies, there is increasing awareness about comprehensive treatment of a patient with MS, which includes psychological and social support as key factors.

Undoubtedly, remyelination drugs, which help the nerve that has lost myelin re-remyelinate and reverse the sequelae, continue to constitute a challenge. But there are already studies in phase I and some in phase II, which means that in 10 years we may have them available.

Research continues, and new treatments that can improve the quality of life of people with this disease are continually appearing.

In this bibliographic review I will address the main questions that one can have when dealing with a patient with MS.

What are modifying treatments for Multiple Sclerosis based on?

• They are preventive in nature.

• Reduce the frequency and intensity of outbreaks.

• Prevent the appearance of new lesions in Magnetic Resonance of the brain.

• They can delay and improve acquired disabilities.

• This treatment will not make you feel better, nor reduce symptoms, nor improve disability acquired from previous relapses.

Are there adverse reactions?

• There are side effects and it is not possible to know beforehand what the reaction to treatment will be in a particular person.

Are the therapeutic options we have today effective?

• Yes, but the treatment must always be modified in accordance with the degree of disability that the patient presents.

What are the fundamental aspects to take into account before prescribing a modifying treatment?

• The risk-benefit for each person with the disease.

• The characteristics of the MS in each particular case (type of MS, outbreaks and their impact, etc).

• The side effects that may appear.

• The mode and frequency of drug administration and monitoring.

• The impact on the patient’s daily life, both emotional and lifestyle.

When should we start treatment?

• Treatment should always be started early.

Do these drugs cure the disease?

• They do not cure the disease or relieve symptoms; they only modify the clinical course of the disease.

Is the help of other specialties necessary to better manage outbreaks and sequelae?

• Yes, for a correct management of this disease, the treatment needs to be comprehensive and include rehabilitation consultation, psychological care, physiotherapy, occupational therapy, speech therapy, etc.

As an MS patient, is there anything I can do to help?

• Healthy diet.

• Avoid stress.

• Avoid respiratory infections and other factors that debilitate the Immune System.

• Healthy lifestyle.

• No Smoking.

• No consumption of alcoholic beverages.

• Responsible attitude towards the disease.

• Positive attitude towards illness, always remember: "The mind cures everything."

What therapeutic options do I have?

As a general rule, the choice of the disease-modifying drug depends on the type of outbreaks that it presents and the physical condition of the patient at the time, thus remembering that the treatment is individualized to improve the course of the disease.

• Ocrelizumab (Mayzent): It was approved by the US Food and Drug Administration (FDA) in 2017. It reduces the rate of recurrence and the risk of disability progression in relapsing-remitting MS. It is also the 1st Disease Modulating Treatment (TME) to slow the progression of the primary progressive form of relapsing-remitting MS.

• Siponimod ( Mayzent): It was approved by the US Food and Drug Administration (FDA) in 2019. This pill is taken by mouth and is approved for relapsing-remitting and secondary progressive forms. It is an immunomodulatory therapy that helps reduce both recurrence and progression of disability.

• Cladribine (Mavenclad): It was approved by the US Food and Drug Administration (FDA) in 2019. This pill is taken by mouth and is approved for relapsing-remitting and secondary progressive forms. In clinical trials this drug slowed the progression of disability and significantly decreased the relapse rate. Due to the risk of side effects this drug is recommended for use when patients do not have other therapeutic options for MS or when these are not effective.

• Stem cell transplantation is also being evaluated as a treatment for relapsing-remitting MS: Researchers are currently exploring the idea whether destroying the immune system and then replacing it with transplanted stem cells can restart the immune system in people with relapsing-remittent MS.

Will there be more options?

• Yes, soon we will have more effective therapeutic options. It is only a matter of time, since there are many studies in completion phases, but so far, we have the above options and some others not as effective as these.

Conclusions

Much remains to be done, but nothing impossible since we are human beings with responsibility and a sense of belonging. There are various Support Groups and Foundations focused on finding an effective cure, and it is estimated that before 2035 we will have many therapeutic options, and MS will cease being one of the most disabling Neurodegenerative Diseases in young patients.