MS news notes: New gadolinium agent, myelin, high-efficacy DMTs
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:
Testing a new MRI contrast agent
One concern that some people with MS have when getting an MRI is that a contrast agent called gadolinium may be used to highlight lesions in the brain. Gadolinium, a chemical element, was the object of a U.S. Food and Drug Administration (FDA) safety advisory in late 2017 related to potential kidney problems in some people.
Although the advisory noted that the FDA wasn’t concerned about people with normal kidney function and that gadolinium’s benefits outweighed its risks, it did raise some concerns. But now, as reported in the MS News Today story “Potentially safer MRI gadolinium-based contrast agent to enter testing,” a Phase 3 clinical trial will study a gadolinium-based product dose that’s about 60% lower than other gadolinium-based contrast agents.
If this new agent — gadoquatrane — is effective, it could ease concerns. That’s important because an MRI is an essential tool for diagnosing MS, and using a contrast agent allows doctors to see lesions that might otherwise go undetected.
Does myelin always protect nerves?
It’s been believed for a long time that the fatty myelin that surrounds our nerves is always a protective coating. But the story “Myelin may promote nerve cell damage in early immune attacks” reports on research showing the opposite may be true in some cases. In other words, myelin-coated nerves may be more vulnerable to inflammatory damage than uncoated ones.
If true, these scientists say, this concept might open new avenues for MS treatment by focusing on regenerating functional myelin rather than preserving myelin that’s been damaged.
Study recommends hitting MS hard from the start
My first disease-modifying therapy (DMT) back in 1996 was Avonex (interferon beta-1a). It seemed to reduce my relapses a bit. But my disease continued to progress.
In 2008, I switched to Tysabri (natalizumab), a higher-efficacy medication, which helped slow my progression. Eight years later, Lemtrada (alemtuzumab) continued to pump the brakes on my MS.
I believe the study covered in the story “Outcomes better for RRMS patients who start on higher efficacy DMTs” is accurate and relevant. To me, it provides more evidence that starting treatment right away with the most effective DMT possible is the best treatment course for people newly diagnosed with MS.
Interestingly, this study also reports that the reason many people with MS stop using their DMTs is because they’re not effective enough. So why do many neurologists still insist on prescribing less-effective DMTs as first-line treatments? Why not at least offer patients the option of hitting their MS hard and fast?
Did you read an interesting MS news story this week? Please share in the comments below.
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.
About the Author
Michael Drohan
Can't speak for every case, but an. unfortunate reason for not always hitting it hard out the gate is Dr. insurance's step therapy requirements.
Ed Tobias
Hi Michael,
You're absolutely correct. See my answer to Beth McKenzie. Also: https://multiplesclerosisnewstoday.com/the-ms-wire/2017/02/17/ms-drug-costs-elephant-examination-room/
Ed
Beth McKenzie
From my experience the Doctors are limited to what the patients insurance will cover. They have to try and fail on multiple medications before a more effective medication will be covered. The cost of DMTs is a huge barrier. While there are copay assistance programs out there, a lot of times patients are left to figure them out on their own.
Also, the medical gaslighting delays diagnoses. I had MS 25 years (according to the age of my lesions) and ended up having a life altering relapse before I was diagnosed. I was told I was being a whiner, exaggerating, to toughen up, well…your are female, stop being lazy etc for many years. Shameful
Ed Tobias
Hi Beth,
You're absolutely right on all counts. Medication cost is the elephant in the examining room, too many neurologists seem unwilling to go to bat for their patients and too many office staffs lack the knowledge and/or desire to help with copay programs.
Yes, too many women have their real medical problems pushed off as "it's all in your mind." And yes, this problem seems to be primarily reported by women. And yes again, shameful.
https://multiplesclerosisnewstoday.com/news-posts/2023/01/05/how-medical-gaslighting-affects-women-chronic-illness-study/
Rachel Wells
Helping my husband with Multiple Sclerosis
What are the best steps to take..
Ed Tobias
Hi Rachel,
Wow, where should I begin? Following the MS News Today patient columnists is a start to getting a good understanding from the view of people who live with MS. There are also a lot of good news articles posted here, although some are pretty technical. This website also has a very good MS Overview section: https://multiplesclerosisnewstoday.com/multiple-sclerosis-overview/
Finally, you can fine many good books about MS on Amazon. Mine is one of them: "The Multiple Sclerosis Toolbox."
Hope this helps,
Ed
Matthew Wolze
I do consider my self one of the luck ones. I was diagnosed 5 years ago. Prior to that I numbness in areas and was told by my primary GP that my symptoms were benign and would go away and they did. That is until my big flare that landed me in the hospital when I had the "hug", numbness in primarily the right leg, but both, in my hands and my right shoulder. I still do have the leg and shoulder numbness. But I do always laugh at the symptoms will go away. When I saw my GP again I told him that he described RRMS, he could not argue that.
I would be interested in trying the new Gadolinium, I believe that when I went for my MRI's that I did have a reaction to it even though I had not before. I am not a big believer in having all of this stuff pumped into me, for every action there its a reaction, basic science!
Thanks for the articles!
Matt
Ed Tobias
Thanks for your comments, Matt. If you click through to the full story about gadolinium you should find a link that will take you to contact information abut the study.
Ed