Patricia Silva, PhD, director of science content —

My disability rights activism includes housing issues. Affordable housing gets a lot of attention (no solutions, but attention, at least). Accessible housing, not so much. Like the invisible symptoms of multiple sclerosis, the need for affordable ACCESSIBLE housing remains hidden. Accessibility needs to be part of the dialogue I…

If you or a loved one is living with multiple sclerosis (MS), it’s important to remember that you can always try to make your situation better. If your doctor says something like “there’s no other option” or “we have nothing more to offer you,” find another doctor. Doctors are humans, too, and they…

The European Medicines Agency has restricted the use of Zinbryta (daclizumab) for relapsing multiple sclerosis after reports of patients experiencing severe liver damage and one dying of liver disease. The temporary order restricts Zinbryta to European Union patients with a highly active disease who have failed to respond to…

B-cells of patients with relapsing-remitting multiple sclerosis (RRMS) secrete substances that are toxic to both neurons and neuron-protecting myelin-forming cells, causing both kinds to die, according to a study. Despite analyses of numerous inflammatory and other factors believed to drive MS processes, researchers were unable to identify the molecules that are toxic, however. Dr. Robert Lisak of Wayne State University in Detroit, Dr. Amit Bar-Or of McGill University in Montreal and their teams are now working on identifying the factor, and learning if the process is also involved in progressive MS. Their study, “B-cells from patients with multiple sclerosis induce cell death via apoptosis in neurons in vitro,” was published in the Journal of Neuroimmunology. It demonstrated that B-cells gathered from the blood of RRMS patients killed lab-grown neurons and oligodendrocyte cells, which form myelin, a protecting coating for nerve cells. Deterioration of the myelin coating and the death of neurons are hallmarks of MS. An earlier study the team conducted indicated that B-cells from MS patients could kill oligodendrocytes. But since the experiments involved only three patients and three controls, the team scaled up their experiments to include 13 patients and an equal number of controls. Both rat and human neurons died when mixed with MS-derived B-cells. In contrast, B-cells from healthy people had little or no impact on the survival of the brain cells. Researchers also discovered that the secreted toxic molecules had no impact on other types of central nervous system cells — astrocytes and microglia. The toxins killed only neurons and myelin-producing cells. The B-cells triggered a process called apoptosis, or programmed cell death, researchers said. This is basically a suicide program. It tells a cell to die when exposed to stressful factors or toxins. The process differs from cell disintegration. Despite thoroughly screening about 40 inflammation-related substances, researchers were unable to identify any factors that caused the cells to die. The National MS Society and the Research Foundation of the MS Society of Canada funded the research, which the U.S. society highlighted in a news release. In the newest phase of the study, researchers will try to learn more about the processes underlying neuron and myelin-related cell deaths and identify the factors responsible. In addition to testing B-cells from progressive MS patients, the team will examine patients with other autoimmune conditions to see if the process is unique to MS or not. Researchers increasingly realize that B-cells are important to MS processes. This observation was underscored by U.S. regulators' approval of the B-cell depleting therapy Ocrevus (ocrelizumab) at treatment for both relapsing and primary progressive MS.

Genentech shared new insights into the workings of Ocrevus (ocrelizumab) and its effectiveness in reducing disease activity and slowing progression in relapsing and primary progressive multiple sclerosis (MS) at the recent 3rd Congress of the European Academy of Neurology (EAN). The new findings, previously reported here, built on analyses of information gathered during the three Phase 3 clinical trials assessing Ocrevus' safety and efficacy, as well as through monitoring patients in extension studies. The studies showed that nearly 40 percent of Ocrevus-treated relapsing patients and nearly 30 percent of primary progressive patients achieved NEPAD during the Phase 3 trials. In contrast, only 21.5 percent of those treated with Rebif and 9.4 percent receiving placebo achieved NEPAD — figures that demonstrate Ocrevus’ impact on patients’ lives, as well as Ocrevus’ ability to slow the decline in walking ability and other types of disabilities are comparable between patients with relapsing and primary progressive disease — data that demonstrate that the treatment acts on disease mechanisms that drive disability in both disease forms. How these effects play out in the long-term is the subject of ongoing research, as Genentech continues to follow these patients in an extension study. In addition, Ocrevus' prescription label strongly advises against pregnancy while on the treatment. Despite precautions, some women became pregnant during the trials. One of the meeting presentations narrated outcomes of these pregnancies; one healthy baby born at term and two ongoing pregnancies in women exposed to the drug. But while Genentech monitors women who become pregnant while on Ocrevus, the number of reported pregnancies is too small to draw conclusions about the treatment’s safety in pregnancy, and researchers do not know if Ocrevus also depletes B-cells in the fetus or in the baby born to a treated woman.

New analyses of how Merck’s Mavenclad (cladribine tablets) act to treat relapsing multiple sclerosis (MS) give researchers an entirely new picture of immune processes leading to the disease. Data showed that the drug lowers both immune B-cells and, to a lesser degree, T-cells. But the numbers of both cell…

It’s never a good idea to jump to conclusions when trying to find a cause for any symptoms you might have. With multiple sclerosis (MS), self-diagnosing is not the way to go. This disease may cause permanent damage even in its earliest stages so it’s crucial to get it properly diagnosed as soon…

Intimacy is often challenging, and sometimes uncomfortable, for anyone, but having a chronic disease like MS just adds another layer to a tough topic. According to the Multiple Sclerosis Association of America (MSAA) there are a number of things that an MS patient can think about in order to rediscover…

The multiple sclerosis therapy Tysabri could trigger melanoma, the Southern Network on Adverse Reactions (SONAR) has warned. Although its investigation failed to demonstrate that melanoma is more common among Tysabri-treated MS patients than in the general population, unusual features among the patients raise concerns about a possible link, the organization said. Contending that current monitoring efforts are inadequate, it suggested improvements that could generate a better understanding of the relationship between Tysabri treatment and cancer. The organization's report, published in the journal Cancer Medicine, was titled “Melanoma complicating treatment with natalizumab for multiple sclerosis: A report from the Southern Network on Adverse Reactions, also known as SONAR." SONAR is an organization that was formed in the Southern United States in 2010 to investigate adverse drug reactions that regulators might not be aware of. Its goal is to reduce the time it takes between detecting an adverse reaction and have regulators act on it. A case that a SONAR investigator came across led to the group investigating possible links between Tysabri and melanoma. A 43-year-old woman developed melanoma in her urethra, the tubing that drains urine from the bladder, after being treated with Tysabri for about two years. Melanoma is most often a skin cancer that is related to sun exposure, but the woman had no skin lesions. After extensive surgery, she relapsed and died when the cancer spread to other parts of her body. She had declined anti-cancer treatment. The case prompt SONAR to look for similar cases. Its investigators found seven studies that involved Tysabri-treated MS patients developing melanoma. In addition, they looked through the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) and the Tysabri Safety Surveillance Program. The surveillance program is part of the Tysabri Outcomes Unified Commitment to Health (TOUCH) database run by Tysabri's developer, Biogen, The research team found 137 cases in the FAERS database through April 1, 2014. The patients' average age was 45. Seventeen percent of the group developed tumors in locations not exposed to the sun, and nine died. The researchers said the database contained only about half the information it should have, such as tumor site, patients' family history of cancer, and earlier immunosuppressive treatment. Fifteen percent of the cases in the FAERS database were based entirely on information from the TOUCH database. Seventy-three percent were cases initially reported to FAERS but with TOUCH information added. Thirteen percent of the FAERS cases contained no additional information. Importantly, there was even less patient information in the TOUCH database than in the FAERS database. Out of eight items researchers believe a database should contain, TOUCH had information on two, on average. “The existence of the TOUCH Safety Surveillance Program, an FDA-mandated program, did not improve melanoma reporting,” the team wrote. This shortage of data stymies research into possible links between Tysabri treatment and melanoma, the researchers said. As an example, although the death rates in the databases were low, there was no information about survival in many cases, which could lead to flawed survival estimates. The investigation noted that patients received a wide range of Tysabri doses before they were diagnosed with melanoma. While some received only one or a few injections, others had been treated for a long time. These observations do not seem to support a link between Tysabri and melanoma, the team said. “A longer therapy duration would be expected if natalizumab caused melanoma via an immunologic pathway, unless existing nevi [lesions of the skin or mucus tissue] were already premalignant lesions,” the researchers wrote. But other information the team found seemed to suggest a Tysabri-melanoma link. For example, the average age of melanoma patients was much lower than that reported in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. The average age in the institute's database is 63, compared with 45 in the FAERS database and 41 in cases in academic journals. In addition, many patients developed tumors in unusual places not exposed to sunlight. Finally, the low melanoma death rate in Tysabri-treated patients differed from that seen in the general population. All these factors suggest that melanoma after Tysabri treatment could differ from other types of melanoma, the researchers argued. While the molecular workings of Tysabri might promote melanoma growth, studies so far have not found a relationship between the drug and this cancer. In fact, some studies suggest that MS patients, in general, have a lower risk of melanoma than others. The team said more information on patients could give researchers a better understanding of the potential relationship between Tysabri and melanoma. The implication was that the standard of reporting in the FAERS and TOUCH databases could improve. To minimize the risk of patients who receive Tysabri developing melanoma, the researchers offered a number of suggestions for IV centers, physicians, patients, and educational programs. For instance, they suggested that all patients should have a skin examination before the start of treatment, and regular physical and skin exams while receiving Tysabri. While noting that risk of infection and the development of tumors can occur with all immunosuppressive treatments, the team said more studies are needed to explore the risk of Tysabri-treated patients developing melanoma.

Problems with sense of smell are more frequent and severe in patients with primary progressive multiple sclerosis (PPMS) than in those with relapsing-remitting multiple sclerosis (RRMS), a study reports. The research, “Olfactory dysfunction in patients with primary progressive MS,” was published in the journal Neurology: Neuroimmunology and Neuroinflammation. A distinguishing feature of RRMS, the most common form of the disease, is attacks of new or increasing neurologic symptoms, such as movement disorders, and then recovery periods. About 15 percent of patients have the primary progressive form, or PPMS. Its main feature is gradually increasing neurologic disability without recovery periods. Some scientists believe PPMS is a less inflammatory course of MS. The differences in the processes that underlie each form are not well understood, however. Several researchers think that studying differences in the two groups' ability to smell — or olfactory dysfunction — could shed light on these underlying processes. Autopsies of MS patients in one study showed that 71 percent had experienced demyelination, or loss of neurons, in the brain's olfactory pathway. The processes that led to this dysfunction were unclear, however. Researchers decided to test the hypothesis that olfactory impairment is more pronounced in patients with PPMS than RRMS. The team examined 32 patients with PPMS, 32 with RRMS, and 32 healthy controls. The yardstick they used to evaluate sense of smell was the olfactory Threshold Discrimination Identification (TDI) Test. It involves patients smelling 48 sniffin' sticks. In addition to an overall TDI, there were subscores on olfactory threshold, odor identification and odor discrimination. Olfactory threshold refers to the lowest concentration of an odor that a person can detect. Researchers found olfactory dysfunction in 27, or 84 percent, of the PPMS patients; 10, or 31 percent, of the RRMS patients; and 1, or 3 percent, of the healthy controls. The TDI score and all subscores were significantly worse in patients with PPMS than in the controls, when considering patients of similar age and the same sex. The TDI score was also worse in PPMS patients than in the RRMS group, after adjusting for age, sex, MS disability level, the length of time patients had the disease, and patients' ability to identify and discriminate among odors. Researchers acknowledged limitations to the study. One was the small size of the groups in the research. Another was not using magnetic resonance imaging, or MRI, to measure olfactory pathway deterioration. Comparing the brain's olfactory pathway region with other brain regions in both the RRMS and PPMS groups could have shed light on the processes underlying the olfactory dysfunction differences between the two, researchers said. “The findings suggest that olfactory dysfunction might be a surrogate of neurodegeneration in these patients," the researchers wrote. "Studies correlating olfactory function with radiologic and clinical markers of disease progression would be of interest.”

The stress of caring for a family member with multiple sclerosis (MS) or another neurodegenerative disease may directly affect the quality of care, according to a study showing that poor caregiver mental health causes higher mortality rates among the patients they care for. The study, published in the journal Proceedings…

TG Therapeutics’ investigational treatment — ublituximab (TG-1101) — led to a near total depletion of B-cells in patients with relapsing forms of multiple sclerosis (MS) taking part in an ongoing Phase 2 trial, the company recently announced. In addition, the company said that ublituximab had an infusion time as short as one hour, without excessive side…

The Multiple Sclerosis Association of America (MSAA) has released three new resources for people with multiple sclerosis (MS), available for free as both printed and online versions on MSAA’s website. According to a press release, the three new resources are: A cover story in the latest edition of MSAA’s…

Shared decision-making between patients and their doctors and healthcare providers was considered a critical step in the process of treating multiple sclerosis (MS), according to an article published in the journal Practical Neurology. The article “Shared Decision-making in Multiple Sclerosis Management” was written by Amy Perrin Ross, a board-certified…

Despite being relatively well-known, there is often some doubt surrounding the causes of multiple sclerosis. According to the National MS Society, there are various factors which could contribute to someone developing MS. Multiple sclerosis, or MS, is a disease that can affect the brain, spinal cord and optic nerves. The effects…

Catheterization training in the hospital did not prepare me for how to manage on a daily basis. In my last column, I described how I ended up in the hospital unable to urinate at all. In this column, I will cover more details about what I learned along…

AXIM Biotechnologies has secured an additional $4 million in institutional financing to advance clinical trials of its cannabinoid therapies for multiple sclerosis (MS) and irritable bowel syndrome. Some of the trials involve a chewing-gum therapy delivery system. The financing will let the company continue developing a patented chewing-gum-delivered therapy for pain and spasticity. AXIM…

The National Multiple Sclerosis (MS) Society has selected research highlights from a recent MS conference in an effort to help make living with the disease less burdensome. Presentations from the May 24-27 annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC) in New Orleans — which ranged from advice on smartphone apps…

Researchers managed to change the immune system — replacing inflammation with immune tolerance — in a mouse model of multiple sclerosis (MS) using so-called quantum dots, or nano-sized particles carrying pieces of myelin. Experiments with this advanced technological solution may help researchers design MS therapies that are based on promoting regulatory T-cells rather…

Previously unpublished results of clinical trials of Lemtrada (alemtuzumab) appears to contain key information as to why many multiple sclerosis patients who use it develop other autoimmune diseases. Researchers looked at the immune cell mix after Lemtrada depleted many of those cells. They discovered that certain B-cells repopulate the body earlier…

The National Multiple Sclerosis Society and a dozen other advocacy groups have banded together to support the Air Carrier Access Amendments Act of 2017, a bill seeking to strengthen the rights of airline passengers and close service gaps often faced by patients with disabilities, including those with multiple sclerosis (MS).

The Maccabees rock band will play an exclusive gig in London to raise funds for the United Kingdom’s MS Society, supporting the organization’s mission of trying to end multiple sclerosis. A key reason for the concert is the group’s passion about the disease. Band members Felix and Hugo White…

A high daily dose of simvastatin improves multiple sclerosis patients’ cognitive function, according to a new analysis of Phase 2 clinical trial results. The British team that did the research will start a study soon on whether simvastatin, which goes by the brand name Zocor and other labels, can also slow…

Already an approved treatment for relapsing and primary progressive multiple sclerosis (MS), Ocrevus (ocrelizumab) is still undergoing scrutiny in several clinical trials. Most focus on the drug’s effects in specific patient groups, but one study aims to advance understanding of how Ocrevus works to harness disease. To do so, the open-label Phase 3…

The MS Minority Research Engagement Partnership Network is calling for all multiple sclerosis (MS) patients, ages 21 and older, to respond to a 15-minute online survey. Investigators are hoping to better understand how people with MS from different ethnic backgrounds and races view medical research, so as to engage them in…

Catheterization was one of my biggest fears when first officially diagnosed with MS in 1994. As the years went by I thought I might be one of the few patients who do not experience malfunction in the urinary system. Then, in 2012, something changed. I went from having to…

Ocrevus (ocrelizumab), a recently approved therapy for relapsing and primary progressive multiple sclerosis (MS), is now on the U.S. market, but research into its use is far from over. Several clinical trials, sponsored by Ocrevus’ developer Genentech or its parent company Roche, are looking at various aspects of the treatment. Multiple Sclerosis…

How multiple sclerosis affects the “social brain,” which governs the ability to understand how others think and feel — a skill called social cognition — is linked to specific types of brain damage that occur in MS: both lesions and microscopic changes taking place in the brain’s white matter, a research team…

The U.S. Food and Drug Administration has approved a supplemental biologics license application for two Bayer products that help multiple sclerosis patients keep track of their injections of Betaseron (interferon beta-1b). The products are the myBETAapp and the Betaconnect Navigator software. A biologics license application is a request for permission to market…

The recent annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC) brought researchers and healthcare professionals to New Orleans to discuss advances — and obstacles to advances — in multiple sclerosis (MS) research. Clinical trials, preclinical studies, basic research, and health interventions were among the May meeting’s focus. Multiple Sclerosis…