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Multiple Sclerosis Treatments: New Routes to Relief

A number of new therapies are on the horizon to treat patients with MS.

By Meera Lee Sethi // Fall 2010
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Eight FDA-approved disease-modifying therapies exist for relapsing forms of MS (the most common disease course), seven of them delivered by injection or IV infusion. These have proved at least partially effective—but no drug works for every patient, and some patients are not helped by any. Now, however, a number of therapies are on the horizon, including the recently approved Gilenya (fingolimod), the first oral MS drug.

MONOCLONAL ANTIBODIES

(Drugs that can block the activity of T cells)



Campath (alemtuzumab):Reduces risk of progression of disability by 9%, compared with 26% for Rebif, an existing drug.

Rituxan (rituximab): Shown to be effective against relapsing-remitting MS and being studied for primary progressive MS.

CAVEAT: Because they modulate the immune system, monoclonal antibodies can weaken patients and increase their risks of infection and cancer. Tysabri (natalizumab), for example, is highly effective but has been linked to 31 cases of a serious brain infection.

ORAL IMMUNOMODULATORS



Gilenya (fingolimod): In one study, resulted in an average of 0.16 relapses per year, compared with 0.33 for Avonex, and significantly slowed disease progression compared with a placebo.

Leustatin (cladribine): Currently used to treat hairy cell leukemia but recently shown to reduce MS relapses.

Laquinimod (ABR-215062): Shows signs of shrinking the number of active MS lesions in the brain.

CAVEAT: Like monoclonal antibodies, oral immunomodulators can leave patients weak and increase their risks of infection and cancer.

NEUROPROTECTORS



Ibudilast (MN-166): Anti-inflammatory; may hold off MS disability by protecting neurons from damage and death.

Cannabinoids: A class of chemicals in cannabis may help protect neurons.

Gilenya (fingolimod): Designed to target the immune system but may also encourage remyelination in damaged areas of the brain.

Stem cell therapy: Stem cells with the potential to differentiate into brain cells critical for regenerating myelin may offer hope for progressive forms of MS.

CAVEAT: Neuroprotection has been described as the Holy Grail of MS treatment, but research is in early stages.

SYMPTOM RELIEVERS



Ampyra (dalfampridine): Strengthens nerve transmissions so they can travel from the brain to the legs even when myelin has been damaged. Can relieve a primary debilitating symptom of MS: difficulty walking.

Amantadine: An antiviral used to treat certain flu infections. Has been shown to help relieve fatigue in some patients.

Cannabinoids: May help with pain and spasticity. Approved for MS therapy in Canada.

CAVEAT: Drugs designed to relieve symptoms do not slow disease progression.

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