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

Columnist Ed Tobias comments on the week's top MS news

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by Ed Tobias |

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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.

Comments

Garic Schoen avatar

Garic Schoen

So when will stem cell therapy be available and covered by insurance for MS patients in the U.S.?

Reply
Colleen Smith avatar

Colleen Smith

Hi Ed- I really appreciate your analysis and info re: living w/ MS. I am currently on Kesimpta & believe it's working... how long & how long to stay on DMT? All questions to ask going forward. I am 54 & feel grateful I have it mild so far. Could you please send me a copy of that study?
Thanks again & best to you
Colleen

Reply
Nancy Rochelle avatar

Nancy Rochelle

Hi Ed
I understand from reading your book that you were diagnosed with MS early but that it was quite some time before you started DMTs, am I right? If so, I wonder if you found you progressed at a slower rate once starting DMTs than before? I think the question you asked above about whether you would have been worse if you hadn’t have started DMTs is key. I wish we knew that answer!

Reply
Ed Tobias avatar

Ed Tobias

Hi Nancy,

I'm glad you've read my book and hope that it's been useful to you.

Yes, I was diagnosed in 1980 and there were NO DMTs until around 1995, when I started being treated with Avonex. Did my progression slow after I began DMTs? Like you, I wish I knew the answer! There's no way to know for sure. However, I can tell you that my relapses decreased after I began Avonex and I THINK the other DMTs that followed did slow things. I particularly think that Lemtrada improved some bladder and bowel symptoms.

Please, if the book was useful I'd very much appreciate it if you'd leave a comment about it on Amazon. Also, please let me know if you have any suggestions for additions or changes. In the next year, or so, I hope to write an updated version.

Ed

Reply
Jen avatar

Jen

"the odds of maintaining employment progressively decrease, according to a recent study"
Can I ask what study you are referring to here?

Reply
Ed Tobias avatar

Ed Tobias

Hi Jen,

There is a like to the study in our story about it. I've just opened the story, to which my column links, and copied the link for you: https://ectrims2022.abstractserver.com/program/#/details/presentations/1008

Ed

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