MS news notes: Stem cell studies, Ocrevus, fenebrutinib, and more
Columnist Ed Tobias comments on the week's top MS news
Welcome to “MS News Notes,” a Monday morning column where I comment on multiple sclerosis (MS) news stories that caught my eye last week. Here’s a look at what’s been happening:
Early stem cell transplants
I’ve read the headline “Stem cell therapy may do most good when given early” or something similar before. In fact, back in 2017, MS News Today published a story titled “Stem Cell Transplants of Greatest Benefit to RMS Patients at Earlier Disease Stages, Study Says.” I think a picture is starting to be painted.
The most recent study reviewed 74 stem cell transplant patients from a single center in Mexico after at least three years had passed. As the story notes, “The findings suggest that stem cell therapy may be most beneficial when given early in the disease course.”
The story from six years ago reported that “stem cell transplants are most effective if done in young multiple sclerosis (MS) patients in early disease stages, who have not gone through several rounds of other treatments.” That study tracked 281 MS patients who underwent autologous hematopoietic stem cell transplantation at 25 centers around the world for more than five years.
I’m a proponent of using stem cell transplants to treat MS. I also believe in treating MS hard and fast. And these two studies, about six years apart, are saying the same thing. So let’s get on with making these transplants more readily available.
Ocrevus appears to limit brain volume loss
Many neurologists use the phrase “time is brain.” They’re referring to how the brain loses volume over time. This happens more rapidly than normal for some people with MS. The story “Brain volume loss with Ocrevus similar to healthy aging: Study” reports on a small study that concludes that people with relapsing MS who used Ocrevus (ocrelizumab) showed that once the treatment reached full efficacy, brain volume loss was about the same as what healthy control subjects experienced through normal aging.
That, to me, is more evidence that using a highly effective disease-modifying therapy (DMT) soon after someone is diagnosed with MS is the best decision for many people who have been newly diagnosed with MS.
A positive report on fenebrutinib
Fenebrutinib is an investigational oral Bruton’s tyrosine kinase (BTK) inhibitor. Two years ago, I wondered if that new class of therapies could be the next big MS medication. As reported in “Fenebrutinib significantly reduced brain lesions in relapsing MS: Trial,” data from a Phase 2 clinical trial show that test subjects had fewer new or enlarged brain lesions and there were no new safety concerns.
I’m pulling for the BTK inhibitors to succeed as a treatment, particularly since they’re administered orally. In my opinion, that’s a lot easier for most people with MS than an infusion or an injection.
Vidofludimus calcium
Another experimental oral therapy in a Phase 2 clinical trial is vidofludimus calcium (IMU-838). As reported in “Experimental MS therapy vidofludimus calcium triggers Nurr1 protein,” it not only appears to reduce inflammation but also may protect neurons. Potentially, it could prevent neurodegeneration and disability accumulation for people with all forms of MS.
It’s encouraging to be reporting positive results this week from studies of two experimental therapies in clinical trials. Each trial like these adds to my hope that I’ll see treatments that will wrestle MS to the ground in my lifetime.
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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Gary Price
I don't understand. Studies are done in Mexico, Great Britain and other places. I'm sure some are done in U.S. but they seem to be repeats of studies done years ago. With the computer power the U.S. has, AI that has been used in other areas, why hasn't a solution been discovered. How many unbelievable cost DMTs have been produced in last ten years? Let's try to get a CURE or is that asking too much? I wonder if the money that has been put in other diseases would also be put in trying for a cure in MS, how long would it be?
Ed Tobias
Hi Gary,
Thanks for your thoughts. Personally, I think scientists are close to preventing MS from occurring, probably with an EBV vaccine. I think they're also close to reversing some symptoms with treatments to repair damaged myelin. Until those goals are reached, I think the research that's resulted in more effective DMTs has been worthwhile. They've certainly come a long way since the first DMTs became available about 30 years ago. I know they've helped me.
Ed
Tom Anderson
Ed, for your info as to ocrelizumab in the study cited above, here is an alternative opinion:
“At least reading the title, the study suggests that ocrelizumab-treated patients with relapsing MS show brain volume loss rates similar to healthy ageing. The catch is in the term ‘similar’.
When you go into the paper and look at the small print, it is clear that the slope of the line of brain volume loss, or trajectory, in the study subjects on ocrelizumab, is faster than the age-matched healthy controls. Therefore, the brain volume loss trajectory in ocrelizumab-treated patients is not similar to healthy controls but occurs at an accelerated rate. It would be interesting to know if these study subjects had slowly expanding or paramagnetic rim lesions quantified. If yes, I suspect these were enlarging and not stable. I would also not be surprised if these subjects were put into a PET scanner that they would have ongoing microglial activation. Similarly, if their spinal fluid were analysed, they would still have local synthesis of oligoclonal IgG bands (OCBs). I am making the point that these patients have worsening MS as a group, which I would call SAW”.
“SAW - smoldering-MS-associated worsening” May 14,2023 Gavin Giovannoni, Neurologist, researcher and author in London
Ed Tobias
Hi Tom,
Thanks for doing a deep dive and sharing the info in language that an average reader can understand. I assume you're a fan of Prof. G. So am I.
Ed
Tom Anderson
"Fan" is probably off a bit or too strong. Honest straight shooter, independent, not partoicularly influenced,... gets my vote. You do that sometimes. MS Today and the Barts associated websites are my sources for monitoring what is currently happeneing. There is a difference between this and them, with MS News Today having a more commercial influence, which for me is interesting to watch. Nice to see my comment wasn't sensored. :-)
Ed Tobias
Tom- Glad we're one of your two MS info sources but a little disappointed that you think I'm only sometimes a straight shooter. I'm always trying to hit that bullseye. As for the commercial influence sure, we sell advertising. But I guarantee you that no advertiser, or anyone else here, has ever even tried to put a spin on my writing. Thanks for reading and also for commenting.
Ed