There are still many questions to answer in the field of multiple sclerosis, particularly when it comes to a better understanding of which drugs and therapies will best treat symptoms and lead to lasting remission.
We sat down with Stanley Cohan, MD, PhD, neurologist and medical director at Providence Multiple Sclerosis Center (Portland, OR) and Pavle Repovic, MD, PhD, neurologist at Swedish Multiple Sclerosis Center and medical director of neurology research at Swedish Neuroscience Institute to discuss clinical trials and research aimed at better understanding of multiple sclerosis.
This is part two of our multiple sclerosis series. Read part one, Understanding Multiple Sclerosis: A Q&A with MS Neurologists.
This blog and the physicians included are supported by the Providence Neuroscience Institute.
Are there new treatment innovations on the horizon for those diagnosed with multiple sclerosis?
Dr. Cohan:
Until 1993, there were no medications of proven value for multiple sclerosis. Now, 30 years later, there are more than 20 medications with varying degrees of effectiveness. Medicines are selected based on the severity and pattern of the disease, as well as the potential risks entailed with use of each of these therapies. More research to develop new therapeutic agents has to be done because effective therapy is still lacking for some types of multiple sclerosis, especially progressive forms of MS. We must also continue to look for safer therapies for all forms of MS.
Among advancing treatment options is a whole new class of medications, called Bruton Tyrosine Kinase (BTK) Inhibitors. There are multiple clinical trials of these agents happening worldwide, and multiple trials of these agents are being conducted at both Swedish Multiple Sclerosis Center and Providence Multiple Sclerosis Center. We hope to have data on the efficacy in the next several years.
Dr. Repovic:
Early work indicates BTK is a promising molecular target in addressing relapses and perhaps progression, or some of the mechanisms underlying progression.
Other pathways are being investigated that have more to do with improving the resilience of the nervous system and neurons to prevent degeneration. One of the therapies in that category is a supplement called alpha-lipoic acid. We are a part of a clinical trial testing the effect of alpha-lipoic acid in progressive multiple sclerosis, in addition to a study investigating BTK therapies.
Dr. Cohan:
A small pharmaceutical company in California has developed a biological engineered white blood cell. Early trials are investigating if these white blood cells can kill the Epstein-Barr virus in the brains of individuals with multiple sclerosis. If these modified white blood cells can clear the virus, that would, in turn change the clinical course of multiple sclerosis.
Can you tell me a little bit about the National African Americans with MS (NAAMS) Registry and why that is important?
Dr. Cohan:
It used to be thought that Caucasians were more likely to get the disease. That is not true. White people were getting diagnosed with multiple sclerosis more often because white doctors took care of white patients, and non-white populations have had well-recognized barriers to care. We know that multiple sclerosis can affect people of any racial or ethnic origin, but the challenges to providing them with the care they need and deserve remain.
The NAAMS Registry was developed by a group of neurologists who specialize in the care of patients with MS, and includes leading African American MS neurologists, to address the lack of studies and research that include African Americans. The goals of the NAAMS Registry are to have an accurate understanding of the number of African Americans afflicted with MS, their potential barriers to care, how this relates to where the patients live and whether certain medications are of more benefit to African Americans, and to improve outreach and treatment for African Americans with MS.
Dr. Repovic:
The reality of the MS clinical trial landscape is that minorities are often underrepresented. If a trial has more than 5% non-Caucasian population, then it’s really an exception. Most of the data that led to the approval of all these drugs derived from the Caucasian population. The field is rightly recognizing that this is important to address. We’re part of those efforts.
What clinical trials are available for individuals with multiple sclerosis at Swedish and Providence?
Dr. Cohan:
We have many, many clinical trials where we are investigating new therapeutic agents and conducting long-term safety studies of current medications. We also have initiated smaller studies to investigate and find new insights into the causes of disease, which we could then use to develop novel agents to treat those causes.
At the Providence Multiple Sclerosis Center, we are working closely with the Providence Cancer Institute on exciting new studies. We are investigating if human molecules injected into animal models of MS can modify genes that regulate the immune system. As multiple sclerosis is a disease that affects the immune system, we are looking to see if these special human molecules can reverse the disease in mice.
Learn more about the clinical trials taking place at Providence Multiple Sclerosis Center.
Dr. Repovic:
In addition to our clinical trials around BTK inhibitors and alpha-lipoic acid (and many others), we are also engaged in a National Institutes of Health (NIH)-sponsored clinical trial in stem cell transplantation. The hope is that truly rebooting the immune system can lead to lasting remission. We want to know, can we reset someone’s immune system so that it relearns more adequately that myelin is not a foreign substance and does not attack it? (Myelin is the substance the body mistakenly attacks in multiple sclerosis.)
That is an extremely promising line of research, and we owe it to multiple sclerosis patients to do it responsibly and carefully. The current trial is called BEAT-MS. We are enrolling* patients with MS for whom some of the moderate efficacy drugs didn’t work out and they are now considering using some of the strongest meds we have. What we are hoping to do in the clinical trial is compare head-to-head stem cell transplant versus best available therapy. Can we do better than best as far as the current medicines are concerned with a stem cell transplant?
*Please note beat-ms is not currently enrolling patients due to the COVID-19 pandemic. The trial is expected to reopen in late March or early April 2022.
Learn more about clinical trials at Swedish Multiple Sclerosis Center.
What advice do you have for someone newly diagnosed with multiple sclerosis or at risk of developing the disease?
Dr. Cohan:
If you do have a first-order relative, the first thing is to discuss your risk with your doctor. If certain types of symptoms appear they may refer you directly to a neurologist. The earlier you are diagnosed and treated, the better the outcome.
Dr. Repovic:
My advice to all newly diagnosed people with multiple sclerosis is to see an MS specialist at least once. You don’t have to continue care with a specialist, but your ability to impact the course of this disease decreases with time. You have this window of opportunity early on to make the most impact on your course of multiple sclerosis and starting early can make a huge difference.
Original source can be found here.
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