MS News That Caught My Eye Last Week: DMTs and Age, Lyvispah, Cells Driving MS, Melatonin

Worsening of Disability Evident in Older Patients Who Stop DMTs

Some neurologists believe that multiple sclerosis (MS) progression slows, or even stops, when people reach their 60s, so they advise patients that there’s no need to continue their disease-modifying therapies (DMTs). Personally, I think a DMT age ceiling is ill-advised. This study agrees.

While older multiple sclerosis (MS) patients whose conditions are stable commonly stop using disease-modifying therapies (DMTs), a study indicates that for a significant number of them this decision can shortly lead to a marked worsening of their disease.

“Our results raise important questions about the accepted practice of discontinuing medications once MS patients are in their 50s and 60s,” Dejan Jakimovski, MD, PhD, a professor in the neurology department at the State University of New York at Buffalo and a study co-author, said in a press release.

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FDA Approves Lyvispah, Granular Form of Baclofen, to Treat Spasticity

Spasticity is one of the most common, and troubling, symptoms for people with MS. So another treatment for it is welcome. Lyvispah is a form of baclofen, a medication that I’ve been using as a pill for many years. But Lyvispah is a powder, not a pill. It can be taken with or without water, or mixed with soft foods. It can also be delivered via a tube directly into the stomach or small bowel. That could be very useful to people with MS who have difficulty swallowing.

The strawberry-flavored formulation, developed by Saol Therapeutics, is particularly suitable for easing flexor spasticity, the involuntary bending of the knees and hips toward the chest, which can be painful and incapacitating. It also may ease spasticity in people with spinal cord injuries, or other disorders involving the spinal cord.

“We are tremendously excited by the approval of Lyvispah,” David Penake, CEO of Saol Therapeutics, said in a press release. “Spasticity is a challenging condition to treat, and we have commonly heard that no two patients are alike. Because of this, clinicians stressed to us that there is a need for new formulations designed to benefit their patients who have difficulty swallowing.”

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Researchers Identify Subset of Immune Cells Driving MS

I realize this is just a mouse study, but as a nonscientist, this seems like a big deal to me. More and more research has pointed to the likelihood that some microbes in the gut affect MS. Singling out the microbes that are the villains that attack our central nervous system would appear to go a long way toward finding a method of preventing those attacks. Am I right?

A new subset of type 3 innate lymphoid cells (ILC3s) — a type of immune cell known mostly for its anti-inflammatory and immunosuppressive effects in the gut — infiltrates the brain and promotes the abnormal immune attacks that drive MS, according to a study in a mouse model of the disease.

“The infiltration of these inflammatory ILC3s to the brains and spinal cords of mice coincides with the onset and peak of disease,” John Benji Grigg, the study’s first author and a doctoral candidate at Weill Cornell Graduate School of Medical Sciences in New York, said in a press release.

“Further, our experimental data in mice demonstrate these immune cells play a key role in driving the pathogenesis of neuroinflammation,” Grigg added.

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OTC Melatonin Improves Sleep Quality in MS Patients, Trial Finds

These researchers report that people with MS make lower levels of melatonin in their bodies than healthy people and that the deficiency might be linked to problems falling asleep and overall lower sleep quality. When the researchers increased the patients’ melatonin, by giving between 0.5 mg to 3 mg pills each night, sleep improved, but not by much  — only 18 minutes out of a seven-hour period. 

Taking the hormone melatonin may increase overall sleep quality in people with multiple sclerosis (MS), a clinical trial found.

The compound, which is available as an over-the-counter dietary supplement, was particularly effective at extending sleep time in patients. Of note, sleep time decreased with age, meaning that “younger participants may have a better response to the use of melatonin to improve sleep,” the researchers wrote.

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