MS Patient’s Pick of the Week’s News: DMTs, Availability, Cannabis, Imaging, Sexual Dysfunction
Here is my Pick of the Week’s News as published by Multiple Sclerosis News Today.
Having progressive multiple sclerosis, the issue of drugs that are disease modifying therapies (DMTs) has never arisen in my treatment options. However, some of the rare side effects of some of the drugs can be somewhat worrying, especially if they include what is euphemistically called a “fatal incident.” That’s death, to put it in plain English.
In general, patients with multiple sclerosis choose their disease-modifying drug (DMD) treatment based on considerations of effectiveness and potential side effects. But the weight they assign to these considerations can differ widely, making it important they are part of treatment decisions, especially regarding DMDs.
These findings are in the report “Identification and Prioritization of Important Attributes of Disease-Modifying Drugs in Decision Making among Patients with Multiple Sclerosis: A Nominal Group Technique and Best-Worst Scaling,” published in the journal PLoS One.
Currently, many different DMDs, aiming to slow relapse rates and disease progression in patients with relapsing-remitting MS (RRMS), are available in the U.S. and Europe (14 are FDA-approved and 11 by the U.K.’s health service) and new ones are being developed. But the effectiveness of DMDs can vary among individuals, as can unwanted effects. For this reason, patients have to play a role in deciding among options, including the option of no DMD treatment at all.
Understanding patients’ preferences regarding DMDs and involving them in the clinical decision-making process can improve both the relationship between health professionals and patients, and the likelihood of treatment adherence over time.
I agree that patients should be involved in the decision-making process, after all, it is a treatment for our bodies that is being decided. But first, patients must be made fully aware of all benefits and side effects.
I have to admit that prior to my own diagnosis, I had hardly given MS much of a thought. However, I can see how some people without the disease could take comfort, on a just-in-case basis, from knowing that therapies exist.
Chronic diseases like multiple sclerosis not only impact patients, they also inspire fear among healthy people who may be at risk of the disease. In a new study, researchers found that the availability of MS therapies provides “peace of mind” value to currently healthy individuals, particularly when the therapies are fully covered by insurance.
The study reporting the findings is titled “Reconsidering the Economic Value of Multiple Sclerosis Therapies” and was published in the American Journal of Managed Care.
The costs of MS healthcare are supported primarily by healthy individuals without the disease. For example, premiums for private health insurance and taxes for public health insurance plans are paid by the entire population, not just those who have the disease.
The value of medical care to the sick is straightforward, but healthy individuals value medical technology because it will be available to them if they become sick in the future, providing peace of mind now.
“The real question in healthcare is whether members of society are getting what they pay for. Our study suggests that, from the perspective of the entire population, MS drugs are much more valuable than previously thought,” lead author Tiffany Shih, PhD, research economist at Precision Health Economics, said in a press release.
Now that more than half the states in the U.S. have legalized the supply and use of cannabis in one form or another, be it medical or recreational, is it time for federal law to be changed?
Voters in four U.S. states on Nov 8 chose to legalize the recreational use of marijuana, and those in three other states approved the medicinal use of cannabis — all gains for pharmaceutical and other companies designing cannabis-based therapies for people with long-term chronic ills whose symptoms might be helped with these products, such as spasticity in multiple sclerosis (MS).
But tensions between current federal and changing state laws also are increasingly evident, and complicate such products’ use.
In statewide ballot issues that also were decided in the recent presidential election, voters in California, a large market (home to about 12% of the country’s population), joined those in Massachusetts, Maine, and Nevada in approving recreational marijuana use and sales. Eight U.S. states now have legal recreational use, including Colorado, Oregon, Washington and Alaska (and Washington, D.C.). Voters in Arkansas, Florida, and North Dakota approved measures allowing for its medical use, bringing to 28 — a majority — the number of states with this approach.
Among the companies that likely will benefit from this growing acceptance of recreational and medical cannabis — expected by analysts to become a $22 billion market by 2020, according to a press release — is GW Pharmaceuticals, whose cannabinoid treatment for spasticity associated with MS, Sativex, is already approved for use in 29 countries outside the U.S.
Now this is what I regard as exciting news. Magnetic resonance imaging (MRI) scanning is vital in both the diagnosis of MSV and in tracking its progress, so any improvements in brain imaging are more than welcome.
Advances in brain imaging are making it possible to visualize early and ongoing events in multiple sclerosis — beginning with the first signs of inflammation caused by immune cells entering the brain.
Now, if the new technique becomes available to physicians, it likely will allow not only for more precise diagnoses, but also for tracking the impact of treatments, both in a clinical setting and when developing new drugs.
The study, “Imaging Matrix Metalloproteinase Activity in Multiple Sclerosis as a Specific Marker of Leukocyte Penetration of the Blood-Brain Barrier,” is the cover story of the latest issue of the journal Science Translational Medicine.
Physicians now can examine the consequences of brain inflammation through MRI. These scans point to changes in brain tissue caused by inflammation, and are an invaluable tool in MS diagnosis, treatment, and research.
But MRIs only show damage that is already present. Scientists from the University of Münster in Germany built on their previous work to create an imaging method that can show inflammation as it happens.
An imaging method that can show inflammation as it happens would not just be an advance, it would be a revolutionary leap forward.
That sexual dysfuncion and depression are linked is, I believe, beyond doubt. The question that has to be asked, however, is more complicated. Does depression lead to sexual dysfunction, or is it the other way around? To me, it could be considered a vicious circle.
In a cross-sectional study, researchers found that sexual dysfunction in patients with multiple sclerosis (MS) is linked to fatigue and depression. Treating these factors and identifying their causes is a potential strategy to treat the problem.
The study, “Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study,” was published in the journal BMC Neurology.
Patients with MS are very often affected by sexual dysfunction, enhancing the burden of the disease, especially in younger patients. While MS can affect sexual function through a variety of mechanisms, both direct and indirect, the exact causes are still a matter of debate.
Now, a team of researchers aimed to determine the prevalence of sexual dysfunction and satisfaction with sexual function in an international sample of patients with MS recruited online as part of the HOLISM study. The team looked particularly at the link between disease characteristics, fatigue, depression risk, and demographics, with sexual function and satisfaction.
I shall await the report of this continuing research with great interest.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.