MS news notes: MSC-NP, GA Depot, AI and MRIs, aggressive treatment
Columnist Ed Tobias comments on the week's top MS news
Welcome to “MS News Notes,” a Monday morning column in which I comment on multiple sclerosis (MS) news stories that caught my eye last week. Here’s a look at what’s been happening:
A different type of stem cell transplant
When stem cell transplant is mentioned to treat someone with MS, most of us probably think of autologous hematopoietic stem cell transplant, which replaces stem cells in the bone marrow that produce immune cells. But a study reported on by Marisa Wexler in “Stem cell therapy MSC-NP can ease inflammatory activity in brain cells” involves a transplant targeting immune cells in the brain.
In this process, mesenchymal stem cells (MSCs) are collected from a patient. These stem cells are programmed in a lab to grow into neural progenitor cells (NPs), which are specialized stem cells that can grow into neurons and other types of nervous system cells. The MSC-NPs are then injected back into a patient’s nervous system through the spine.
The therapy is known to reduce disease severity and improve myelin regeneration in animal models of MS. The results of a Phase 1 clinical trial with 20 patients with progressive types of MS showed that most patients experienced improvements in their functional abilities following the therapy. In some patients, improvements lasted at least two years. A Phase 2 trial is now underway.
It’s very encouraging to see more MS research involving stem cell transplants. I’d like to see more use of the treatment in the U.S., and I think many other people with MS would agree.
A longer-acting form of glatiramer acetate
Glatiramer acetate is a generic form of the disease-modifying therapy (DMT) Copaxone, which requires a self-injection once a day or three times a week. Those frequent shots can be a problem for some of us. They certainly were for me when I was being treated with Avonex (interferon beta-1a), a weekly injection. I got needle fatigue after a few years.
So I’m sure people with MS will welcome GA Depot, a version of glatiramer acetate that requires an injection only once a month.
The story “ACTRIMS 2023: GA Depot found to ease MS disability in Phase 3 trial,” by Lindsey Shapiro, provides details of an ongoing Phase 3 clinical trial of this experimental medication.
Artificial intelligence and MRI scans
Artificial intelligence (AI) is being used for many things these days, so why not use it to interpret MRI scans? The story “Icobrain MS, an AI tool for assessing MRI scans, being tested in UK” reports on a study looking at how well AI technology can interpret MRI data and how the technology might influence patient care.
The project is called AssistMS. According to MS patient Rachel Horne, who is the patient and public involvement lead for AssistMS, “neurologists will be able to get a much more accurate idea of how each patient’s disease course is progressing and, in turn, to recommend the best possible treatment for that person.”
Aggressive treatment gaining support among neurologists
I’ve always been a supporter of treating MS aggressively. In my opinion, the best way to attack this illness is by hitting it hard and fast. It appears that more and more neurologists are agreeing with this approach.
As reported in the story “Ocrevus and early start with aggressive treatment favored in US,” a survey of neurologists found that the therapy they are most satisfied with is Ocrevus (ocrelizumab), a high-efficacy DMT. They also report high satisfaction with Kesimpta (ofatumumab) and Tysabri (natalizumab).
The survey also reports that neurologists are moving to start patients on these treatments earlier than they have in the past.
Because MS can progress silently before symptoms are noticed, and because a loss of treatment time can mean more damage, I say bravo to this early, aggressive treatment approach.
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.
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Karin Aubrey
Regarding the "Aggressive Treatment is Gaining Support"... I am wondering how much has been looked at for patients like myself that are A) older, B) already failed due to major side effects of these aggressive treatments, C.) What is the suggested approach after such failure? I have SPMS, and was treated with Tysabri shortly after Dx. Then my JCV status changed and I came off of that drug. I was thrust onto Mayzent and in less than a year had a total crash of my immune system, meaning that I couldn't fight off an infected hang nail. I was very sick and had infection after infection. I am currently on Aubagio while deciding what to do next. I am less than a year off of the Mayzent and I do not feel that my system has recovered yet from that fiasco. My new neuro is pushing hard for Ocrevus and wants it started yesterday but I am 65 years old now and I am just tired. I spent the better part of my life looking for the Dx, then to have this happen within a few years of getting the Dx, late in life and now feeling like I am being bullied into something I do not want. At what point is there a line drawn as to patient quality of life and sense of well being, over the perceived tiny gains, MAYBE over some arbitrary future possibility of further disability? I am 65 and have a EDSS score of 6.5. I will be on a walker soon as my knees are failing but not due to MS directly. Rather avascular necrosis from the massive steroid use in treatment of MS, pain conditions and chronic lung disease.. IDK. It gets to a pojnt where it seems the "Do no ahrm" is thrown by the wayside when the patient, themselves, are not considered in treatment plans.
Ed Tobias
Hi Karin,as
I'm so sorry you've had these problems. I'm 74 years old and was DXed with MS 42 years ago. My EDSS is also 6.5 and has been for several years. I use two canes for very short distances (100 steps, or so) and a scooter for longer. In December, 2016, when I was 68 years old I decided to try Lemtrada. It was my choice and I think it bought me a few more years of slow progression. But my neuro and I knew before I started that after two years of treatments it would be my final DMT. (I was treated with Avonex, Tysabri and Aubagio earlier). I did ok on Lemtrada, managing some temporary side-effects, mostly serious fatigue, well. But I wouldn't recommend it for everyone at that age. Yes, there comes a point where enough is enough. If that's the way you now want to live your life you need to stand up for yourself. A treatment decision should be a collaboration between patient and physician, but the patient must have the final say.
Ed
Martha Senturia
I was diagnosed at 53 after a pretty rough relapse, but likely had MS for several years prior like many others. I am so grateful that my neurologist was on board with aggressive treatment from the start (no bullying, but he went to bat for me with insurance companies etc.) I've been on Tysabri for almost four years, and my MRIs are steady (with some improvement in the brain lesions). I feel like it has changed the trajectory (or delayed disability progression) for the better, and I hope everyone else who can tolerate the stronger treatments is as fortunate.
Ed Tobias
Good for you, Martha! I'm so glad Tysabri has worked well for you and I hope it does the same for others.
Ed