MS Research Update
Written by Susan Wells Courtney
Several medical organizations from around the world hold extensive annual meetings to update medical professionals on the latest information available on disease research and treatments. During the spring of each year, the American Academy of Neurology (AAN) and the Consortium of Multiple Sclerosis Centers (CMSC) are among those organizations holding international meetings dedicated to neurological conditions and multiple sclerosis (MS).
Staff members from MSAA attend these meetings to provide information to members of the medical field, so they may inform their patients of MSAA's vital programs and services. MSAA's staff also attends educational sessions to learn about new treatment approaches and ways to further help members of the MS community.
Through a large survey conducted by MSAA, individuals with MS have expressed a strong desire for the latest news in MS research. In response to this need, MSAA strives to offer this information through its website and publications, particularly in articles such as this one appearing in The Motivator.
Numerous trials are currently being conducted to determine the safety and effectiveness of medications for the treatment of MS. Trials not only include experimental drugs and therapies, but also FDA-approved disease-modifying therapies (DMT) for MS, where various drug and dose combinations are studied, and long-term efficacy as well as safety are continually re-evaluated.
On the pages to follow is a listing of the six FDA-approved drugs as well as a number of experimental drugs currently being studied in the treatment of MS. Below each listed medication are several highlights about the drug and related research. This is not a complete list and space does not allow for all studies and their results to be included. Please note that in many instances, initial study results should be considered as preliminary. Additional studies and/or evaluations are needed before these findings may be confirmed.
Many readers of The Motivator are well-versed in MS terminology and disease pathology, but anyone wishing to review the basics, or learn about them for the first time, may choose to first read the Health and Wellness column in this issue. Beginning on page 48, this column gives an overview of MS, evaluative procedures, how clinical trials are conducted, and treatments. This information may be helpful in better understanding the research information to follow.
FDA-Approved Medications for the Treatment of MS
Experimental Oral Medications for the Treatment of MS
Experimental Monoclonal Antibody Medications for the Treatment of MS
Other Therapies Being Studied for the Treatment of MS
The preceding overview of approved and experimental drugs for MS is only a fraction of the many treatments presently being studied. Some of the other disease-modifying investigational drugs and therapies include familiar ones, such as azathioprine (Imuran®), corticosteroids, cyclophosphamide (Cytoxan®), immunoglobulin; methotrexate, methylprednisolone, plasma exchange, and stem cell therapy, along with lesser-known ones, such as A4I, CDP323, minocycline, mycophenolate mofetil (CellCept®), pioglitazone (Actos®), SB-683699, and Topamax® (topiramate).
Some drugs, such as lamotrigine and riluzole, are specifically in trials for neuroprotection (to keep nerve fibers and the myelin intact). The latter drug, riluzole, is also in a trial to study its effectiveness in patients with chronic cerebellar ataxia.
The preceding overview also listed one drug for symptom management, Famprindine SR (for walking and strength). Once again, several other drugs and therapies are being investigated. For example, Avanir Pharmaceuticals' Zenvia™ (formerly Neurodex), is a drug in development for involuntary emotional expression disorder (IEED) in patients with MS. IEED is characterized by sudden and unpredictable episodes of crying, laughing, or other displays of emotion. In response to safety concerns raised by the FDA, Avanir Pharmaceuticals is planning a confirmatory Phase III study with a new, lower-dose formulation of Zenvia.
Several trials are either planned or in progress for the treatment of other MS symptoms as well. Ritalin, memantine, donepezil (Aricept®), and Provigil® (modafinil) are all being investigated for their effects on cognitive function. In addition to evaluating the effect of sleep on fatigue, treatment trials for fatigue include: 3,4-diaminopyridine, aspirin, Provigil, sublingual tizanidine tablets, and Tysabri (in a study named "ENER-G"). Studies planned or in progress for spasticity include cannibis-based medicine extract (Sativex), IPX056, and sublingual tizanidine tablets.
Neuropathic pain, which is a common and debilitating issue in MS, has a number of potential drug treatments. Studies are in progress or planned for: lidocaine, extended-release oxycodone, Cesamet® (nabilone) alone or with gabapentin; pregabalin, paroxetine, duloxetine, Sativex, and levetiracetam. The latter drug, levetiracetam, is also under investigation for tremor in MS. Trials for the treatment of optic neuritis include simvastatin, as well as erythropoietin in conjunction with methylprednisolone. Botulinum Toxin Type A is being tested for its effectiveness in treating overactive bladder.
Additionally, cranberry is being studied for the prevention of urinary tract infection (UTI). Whole Body Vibration Therapy, and training with APOS (All Phase of Step Cycle) Kit, are each under investigation to improve balance. With Depression, which is traditionally treated through medications and counseling, researchers are looking into the positive effects which may be gained from fish oil.
Occasionally, readers of The Motivator have contacted MSAA inquiring about treatment with low-dose Naltrexone (LDN). No scientifically acceptable data are available, however, the University of California in San Francisco is currently sponsoring a Phase III trial of LDN. This study will compare individuals treated with LDN to those receiving a placebo; treatment responses will be determined by quality of life composite scores.
As mentioned earlier, this article does not include all of the potential drugs and therapies under investigation for the treatment of MS and it symptoms, but it does include a good number of those receiving much attention at this time. Anyone interested in additional information about these clinical trials, or anyone interested in participating in a clinical trial, may visit www.clinicaltrials.gov. This website is a service of the United States National Institutes of Health, developed by the National Library of Medicine.
The Future of MS Research
Experts from around the world are passionate in their quest to identify the causes of MS and the changes in the body which occur as a result. Scientists look to improve the methods of observing and measuring disease behavior, using the most advanced technology available.
Researchers today are more aware of the cellular makeup of the different types of lesions. A lesion's appearance and its degree of inflammation or injury provide a window into the processes that are occurring. From this vital information, scientists and pharmaceutical companies begin the long road to drug approval, starting in a laboratory and devoting years of study before reaching an MS patient. Future research will continue to look for clues into the mysteries of MS.
Among topics of growing interest is the mounting evidence behind sunshine and vitamin D's potential role in the development of MS. Vitamin D may offer some protective properties, but more studies are needed. A viral component may play an important role as well; individuals infected with the Epstein-Barr virus (EBV) may be at an increased risk of developing MS, with a possibly greater risk for those with a history of mononucleosis (a manifestation of EBV infection). Studies also support the theory that cigarette smoking increases the risk of MS, while smoking has already been tied to a faster transition from a relapsing type of MS to a progressive type (RRMS to SPMS). Additionally, genetic factors have long been known to increase one's chances of developing the disease. More specific genetic associations (genes for interleukin 2 and 7 receptor alpha) appear to be associated with immune dysfunction in MS.
These are just a few of the many areas of study that are providing important insights into the development and behavior of MS. With six FDA-approved disease-modifying therapies already available for the treatment of MS, and many more investigational drugs and therapies in the pipeline, the MS community has much to look forward to in the coming years.
|Last Updated on Friday, 14 September 2012 13:23|