Slowing The Progression of Multiple Sclerosis
- Friday, August 14, 2009, 10:25
- Multiple Sclerosis
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- Dick:
- People with MS may experience relapses or have these exacerbations that we’ve been talking about. How are they treated, and do you agree that that may not be the primary consideration?
- Dr. Stefoski:
- Relapses, exacerbations, or “attacks” of MS, if you will, are important. They need to be treated, but they are probably not crucial in assessing how well a medication is working or protecting a given person with MS. But yes, they need treatment. I do treat most of the attacks of MS with intravenous Solu-Medrol. We call this high-dose intravenous steroids. Very rarely do I treat them with oral steroids. It’s only if MS attacks are rather mild.
- Dick:
- Is that a significantly different treatment from the treatment in early onset MS or early diagnosis MS?
- Dr. Stefoski:
- Not necessarily. Steroids are used for treating relapses or attacks of MS at any point, whether it’s early in the course of MS, middle or late. Steroids are probably the best for attacks. For other treatments, we use other medications.
- Dick:
- Let’s talk about that. What medications do you use for people who have progressive forms of MS?
- Dr. Stefoski:
- There are two basic forms of progressive MS. One is what we call secondary progressive multiple sclerosis, and that is what happens in people who initially present with what’s called relapsing or relapsing-remitting MS, which has attacks, and then kind of quiets down and again attacks. And after a while, in about 10 to 15 years, they become progressive. They still may have attacks on top of progressive MS, and they may have to be treated differently. And my approach is that in addition to the medication the person is already taking, whether it’s Avonex, Betaseron or Copaxone, to try and subdue the relapses or attacks of disease and control the dragon, if you will, by increasing the firepower, and that is by adding another medication. There are several of these medications that can be used, including the intravenous steroids. Some of the other ones in use are generally in the category of chemotherapy medications used often in cancers. [Editor's comment: These medicines tend to work by having an immediate impact on the activity of the immune system, to interrupt the immune damage that occurs in a relapse or attack of MS.] They can be either oral or intravenous. For more slowly progressive people with MS, we use oral; for more rapidly progressing ones, we use intravenous ones.
And then there is the other type of progressive multiple sclerosis, which is rarer, and that’s primary progressive MS. Only about one in ten people with MS have that form. And that is the most difficult form of MS to treat. Generally, one tries any of the medications available and sees what works, so it’s a trial and error in primary progressive MS.
- Dick:
- Next an e-mail question, “Will we ever see a non-injectible or oral form of these ABC medications?” And I assume implied in that question, an oral form that’s just as effective as the injectible form.
- Dr. Skeen:
- I guess the quickest answer to that is it’s not on the horizon right now. Of the ABC drugs, the only drug that has been tried to my knowledge in an oral form is Copaxone, and that data has not been published formally, but the best way I can say it is it’s not very promising. We all were hoping. My greatest fear was that it might be a little effective and that all the folks with MS would take it because it was a pill and not an injection but not have the greater efficacy of the three drugs that are injectible that we now have. But it looks like it’s not very effective; I’ll put it that way.
“The ABC drugs are not cures, so some degree of progression can be expected in people who are taking any one of these medications.” And clearly, the interferons, the Avonex and the Betaseron, there’s plenty of evidence to suggest that if they had to pass through our stomach, etc., they would degraded into a point that they would not be effective. So, I can tell you that all of the pharmaceutical companies are working on trying to find other ways to give the medications, but we don’t have much evidence to date that it’s coming soon.
- Dick:
- What would you say are the long-term effects of taking any one of the ABC medications?
- Dr. Stefoski:
- They basically slow down the progression of the disease. They are not cures, so some degree of progression can be expected in people who are taking any one of these ABC medications.
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