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New drugs offer hope for multiple sclerosis patients

Swedish Medical Center | July 5, 2010

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Although multiple sclerosis (MS) remains incurable, there are more than a half dozen drugs now available that have been shown to be able to slow progression of the disease and scores of new drugs are in clinical trials.

Dr. Lily Jung meets with a patient at Swedish’s Multiple Sclerosis Center.

“It would be hard to find another condition for which so many drugs are in development,” says Dr. James Bowen, medical director of Swedish’s Multiple Sclerosis Center. All told, there are about 75 drugs for MS in human trials and about an equal number in animal studies, Bowen said.

MS is an autoimmune disease in which the white cells attack myelin, a material that sheathes the long, wire-like processes of nerve cells, called axons, that transmit signals from nerve cell to nerve cell. Damage to the myelin sheath impairs the ability of axons to transmit those signals and can eventually lead to the destruction of the axons and death of the nerve cells themselves.

“The cause of multiple sclerosis remains a mystery,” says Dr. Bowen, nor is it known why the Northwest has one of the highest rates of MS in the world, but genetics may play a role. MS is more common among people of northern European descent, as are many residents of the Northwest. It is also more common among people who grew up in higher, temperate latitudes such as the Northwest.

The severity of MS varies from person to person. In some cases, the symptoms are mild; in others the disease can progress rapidly. Studies from the 1980s found that after 20 years of being diagnosed, with 15 percent of patients had minimal disabilities but 25 to 35 percent needed a wheelchair, Dr. Bowen says. The remainder had symptoms somewhere in between.

But those studies, Dr. Bowen notes, were done before the current disease-modifying drugs, such as interferon beta, marketed as Betaseron, had become available. These disease-modifying drugs, which block the immune system’s attack on myelin, do more than just treat symptoms but can actually change the course of the disease and slow the progression of MS, delaying the onset of more severe symptoms and disability.

There are side effects to consider and the drugs may not be right for everyone—some drugs require regular injections, which some patients find difficult, says Dr. Bowen, but the vast majority of patients will benefit and should be on these drugs.

Many of the new drugs under development either require fewer injections, say once a month, or can be taken by mouth, eliminating the need for injections altogether.

Just how effective treatment with disease-modifying drugs will ultimately prove to be in reducing disability over the long term is not yet known because they haven’t yet been around long enough, said Dr. Bowen, but current evidence indicates that in most cases the sooner patients start the drug the better.

Dr. James Bowen

Even if their first episodes of multiple sclerosis were mild and fleeting, patients should consider starting what disease-modifying drugs sooner rather than later, says Dr. James Bowen. “Unfortunately, a lot of patients are not being offered these drugs,” he said.

The Swedish Multiple Sclerosis Center, one of the largest in the nation, sees about 3,000 patients from around the region, across the country and abroad. The idea for the center was to create a place where patients with MS could get a full range of services to help them better cope with this lifelong disease.

But ultimately, however, drugs are only part of the care plan, says Dr. Bowen. The center focuses on a team approach to provide in addition to medical diagnosis and treatments, such services as physical and occupational therapy, complementary therapies, psychological counseling and patient support groups where patients can share ideas, experiences and concerns. There is an emphasis at the center on wellness, with exercise, nutritional health and emotional support to help those with MS achieve their optimal function, saidys Dr. Bowen. “We really try to take care of the whole person,” Dr. Bowen said.