SPMS Triggers and Treatments Among Focus of Expert Panel in Video Series by AJMC

Multiple sclerosis (MS) experts discuss disease causes and current treatment options in a new video series released by the multimedia and peer-reviewed science journal, The American Journal of Managed Care (AJMC). 

The free and online video series is part of its “Peer Exchange” initiative, featuring discussions between a panel of opinion leaders representing different therapeutic areas to help guide best practices in disease management. 

This series is titled “Identifying Secondary Progressive Multiple Sclerosis,” and features on its panel:

• Peter L. Salgo, MD, a professor of medicine and anesthesiology at Columbia University Vagelos College of Physicians and Surgeons, and an associate director of surgical intensive care at New York-Presbyterian Hospital (moderator).
• Patricia K. Coyle, MD, a professor and interim chair of neurology and director of the Multiple Sclerosis Comprehensive Care Center at Stony Brook University.
• Thomas P. Leist, MD, PhD, director of the Comprehensive Multiple Sclerosis Center at Jefferson University.
• Maria Lopes, MD, MS, former chief medical officer of Magellan Rx Management.

“The panel of experts featured in this educational video series … will outline secondary progressive MS and all treatment options to achieve the best possible outcomes for patients,” Michael J. Hennessy Jr., president of MJH Life Sciences, the parent company of AJMC, said in a press release.

The video series begins with an introductory discussion defining MS and various aspects of disease management.

Leist opens with a talk about recent advances in understanding the pathology of MS. Previously, he says, “we were thinking of multiple sclerosis largely as a white matter disease [affecting conduction and muscle/motor skills]. Now it’s clearly recognized that pathophysiologically, the more important part, is probably also the gray matter pathology [affecting cognition].”

He emphasizes that MS is “a whole brain disease,” and that it “affects essentially the functioning of the individual, and multiple sclerosis is not a T-shirt that says ‘One size fits all.’ There is high variability between individuals.”

Lopes, in turn, discusses the economic burden of living with MS. She notes that direct costs, such as health plan spending on disease-modifying therapies, are relatively easy to calculate. However, as MS patients “lose function, their employability and productivity start to decrease. And so with that comes indirect costs. The impact on family, on dynamics.”

“With a growing prevalence, it’s obviously an exciting time for MS as we link this to more treatment options, but definitely a very high cost disease,” Lopes adds.

Concerning this economic burden, Coyle mentions that “the National MS Society has estimated the care of MS patients annually costs about $70,000, and in total probably $28 billion a year.”

In the second video, this same panel of experts discuss whether MS is an autoimmune disease.

“I don’t like to call it autoimmune,” says Coyle, “because we’ve never identified an autoantigen target [a molecule that triggers an immune response].

“There’s no doubt that the host immune system is attacking and causing damage within the CNS [central nervous system]. It’s an immune-mediated disease, that’s a definite component. All of our DMTs [disease-modifying therapies] manipulate the immune system, and they are successful,” she adds.  

In discussing likely triggers of MS disease, Coyle mentions genetics and environmental factors. As one interesting environmental factor, she says: “for example, there is no adult onset MS case that’s not Epstein-Barr virus [EBV] antibody positive.”

Panel members also discuss how current research suggests that EBV may trigger MS by infecting immune cells, allowing them to survive beyond their usefulness, leading to autoimmune activation.

“It’s a confluence of the genetic makeup of an individual plus what has happened to this individual immunologically. Keep in mind that Epstein-Barr virus, after you acquire it, it is within your body. Where does it survive? Among other things, it survives in B-cells and T-cells … It gives this T-cell and the B-cell an ever so slight survival advantage,” Leist says.

“If you have an ever-so-slight survival advantage because of Epstein-Barr virus,” Leist continues, “you may not go away when you should go away, which then leads to an ongoing autoimmune disease or immune activation.” 

This video series will continue to discuss in detail the various types of MS and treatment options that follow National MS Society recommendations. They will also highlight the importance of early MS treatment, and helpful lifestyle modifications.