MS News Notes: Stem Cell Transplant Versus DMTs, Treatment Efficacy, Cancer Risk, Employment

Welcome to “MS News Notes,” where I comment on multiple sclerosis (MS) news stories that caught my eye last week. The articles in today’s column came from the annual Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held Oct. 26–28 in Amsterdam. Most of them deal with disease-modifying therapies (DMTs).

Stem cell transplant or DMT?

In “#ECTRIMS2022 — Analyses Weigh Stem Cell Transplant Versus DMTs,” MS News Today’s Marta Figueiredo, PhD, discusses an analysis that compared autologous hematopoietic stem cell transplants (aHSCT) with high-efficacy DMTs in patients with relapsing-remitting MS (RRMS), secondary progressive (SPMS), or primary progressive MS.

In the study, 144 patients given stem cell transplants were compared with 769 patients on Gilenya (fingolimod). Also, 146  patients who received aHSCT were matched with 730 patients treated with Tysabri (natalizumab), and 110 patients in the aHSCT group were matched with 343 patients given Ocrevus (ocrelizumab). The results depended on the DMT and the patient’s particular stage of MS.

Autologous hematopoietic stem cell transplant is superior to Gilenya and Tysabri at preventing relapses and reducing disability in people with highly active RRMS.

In turn, aHSCT appears to be as effective as Ocrevus in RRMS patients and also was not superior to Tysabri in people with progressive MS.

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How long are DMTs effective?

Over the years, research has shown that DMTs can help lessen the frequency of MS relapses. Some DMTs also slow disease progression. But does a time eventually come when disability progression continues no matter what? The MS News Today story “#ECTRIMS2022 — DMTs Ease SPMS Disability Early but Not Over Time,” by Lindsey Shapiro, PhD, reports on an analysis of more than 10,000 people in Europe with MS.

This study is of particular interest to me, as I’ve been living with MS for over four decades and have been treated with four DMTs. Have these DMTs slowed my MS progression? I do think so. Have they stopped it? Nope. Would I be worse if I hadn’t been treated with DMTs? I really don’t know.

Early use of DMTs among people with SPMS may lead to overall lower levels of disability, according to a new analysis.

But staying on treatment does not appear to significantly slow disability progression over time.

DMTs and cervical cancer risk

All of us with MS know that choosing an MS treatment requires balancing possible risks with potential rewards. This is especially true with high-efficacy DMTs. One of those risks is discussed in “#ECTRIMS2022 — High-efficacy DMTs Linked to Cervical Lesion Risk.” In findings presented at ECTRIMS, researchers suggest this may be due to the moderation of the immune system that results from treatment with these DMTs, making women more susceptible to infection with human papillomavirus, or HPV, and strains of HPV can lead to cervical cancer.

Exposure to high-efficacy disease-modifying therapies is associated with an increased risk of cervical abnormalities in women with multiple sclerosis, recent data suggest.

The findings are consistent with previous reports showing these treatments may raise the risk of certain cancers, likely as a consequence of their immune-modulating effects.

Holding a job may get harder

It’s not always the case, but as the story “#ECTRIMS2022 — Job Prospects Can Slowly Take a Hit After CIS Diagnosis” notes, it can be hard to keep a job when you have MS symptoms such as cognition fog and fatigue. I regularly read on MS social media groups about people who lose their jobs because of too many absences, who can’t manage the stress, or who need to take frequent breaks due to their MS. Understanding the many dimensions of this disease, researchers say, is important to developing work retention programs for people with MS.

In the years after a diagnosis of clinically isolated syndrome — a first episode of neurological symptoms suggestive of multiple sclerosis — the odds of maintaining employment progressively decrease, according to a recent study.

The risk of decreasing or losing employment was particularly high among individuals who later transitioned to a clinical diagnosis of MS, and among women and people who experienced more relapses or greater disability.

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, and are intended to spark discussion about issues pertaining to multiple sclerosis.