MULTIPLE SCLEROSIS (MS) is an inflammatory demyelinating disease of the central nervous system, characterised by ongoing disease activity, with profound effects on patient independence and quality of life (QoL).
This is the textbook definition of MS, however, treating it is not so copy and paste. Two weeks ago, pharmaceutical giant Roche, held a symposium at Hyatt Regency, Port of Spain, with medical manager for the Central America and the Caribbean Dr Arnoldo Soto and MS patients.
During the lecture, Soto, a neurologist, said the disease has no known cause or cure. He added that diagnosis is only done through a process of elimination as there is no standard tests for the disease. Soto said that in his discussion with MS patients and their relatives, most of the symptoms are unpredictable. Fatigue, pain, mobility impairment, muscle weakness, memory loss, respiratory problems and seizures are just some of the many symptoms patients with MS experience. Treating MS is ultimately about managing the symptoms as no two patients are the same, making it even more difficult. While magnetic resonance imaging (MRIs) can show lesions in the brain, which is consistent with most MS patients, some scans do not show the lesions, leaving patients undiagnosed.
“Caregivers of patients with MS have high levels of distress and a reduced quality of life. Their distress is mainly associated with the psychiatric symptoms and cognitive impairment of the patients and their physical impairment,” Soto said then adding that there is sometimes a trade-off between efficacy and safety.
Some of the drugs used locally to treat MS are Fingolimod, Rituximab, Beta Interferon and Roche hopes that their latest drug Ocrelizumab will be available soon. Rituximab is described as a wonder drug but was designed to treat leukaemia, however, doctors have seen progress in patients using it to treat MS.
Asked about the treatment regime, Soto, in an emailed response said: “The treatment is for life. It is not recommended to stop the medication the patients is currently receiving, and it is important to keep an open communication with the healthcare professional in case of any treatment changes. Treatment adherence is key for MS patients; when taken adequately, these medications improve quality of life and allow a regular life for patients who follow the physician’s recommendations.”
He added that there is no best unique treatment as each treatment is personalised according to the type of MS. There are three types of MS: the primary progressive multiple sclerosis (PPMS), the relapsing remitting multiple sclerosis (RRMS) and the with secondary progressive multiple sclerosis (SPMS). For PPMS the new drug is Ocrelizumab while for RRMS there are 15 different treatments on the market. Patients with PPMS now have two approved medication available to them.
“We hope not just to treat the disease but to cure it,” Soto said at the conference as he informed the patients and their caregivers of Ocrelizumab, which in their clinical trials had a high no evidence of disease activity (NEDA). Ocrelizumab targets the RRMS form of MS to reduce patients’ relapses.
“With the spectrum of treatment options available, covering all types of MS, now more than ever, the diagnosis is far from being a death sentence for these patients. We know for sure that without appropriate treatment these patients have a high probability of being in a wheelchair in 15 to 20 years after the MS diagnosis is made. On the other hand, we know that if proper diagnosis is made and the correct medications is started early in the disease, these patients have a high probability of living a productive and normal life,” Soto said in his email.
World MS Day is celebrated on May 30. This is the second story in a series leading up to that day. Next week's article will focus on a MS patient who lives with the primary progressive MS and now uses a wheelchair.