MS Patient’s Pick of the Week’s News: Aggressive Therapies, Early MRIs, Tysabri and More

Here’s my Pick of the Week’s News, as published by Multiple Sclerosis News Today.

Best First-Line Treatment for Aggressive MS May Be Equally Aggressive Immunotherapies

Sounds like “Fight fire with fire” to me; could be just what is needed.

Patients with aggressive onset multiple sclerosis, characterized by a rapidly progressing disease course and accumulation of disability, may benefit from early aggressive therapies instead of the escalation approach commonly given multiple sclerosis patients, according to researchers at Weill-Cornell Medical College.

Their article, titled “A study of patients with aggressive multiple sclerosis at disease onset,” was published in the journal Neuropsychiatric Disease and Treatment.

The clinical course of MS is highly variable, ranging from a relatively mild disease that takes years to progress, called benign MS, to an extremely virulent and disabling disease known either as malignant MS, highly active MS, or aggressive onset MS (AOMS).

Since current disease-modifying drugs for MS are anti-inflammatory, it is important to identify the therapeutic window of opportunity that would best control the disease in its inflammatory phase, when treatment has the greatest chance of delaying onset and severity. But the current lack of uniform criteria or guidelines to define AOMS patients at disease onset hampers the development of rigorous studies addressing best treatment options for these patients.

Weill researchers selected a set of criteria that could be easily applied in clinical practice to diagnose AOMS within one year of diagnosis. They are: two or more relapses in the year after onset, and two or more gadolinium-enhancing lesions seen in brain magnetic resonance imaging (MRI); or one relapse that results in sustained baseline EDSS (Expanded Disability Status Scale) score of 3, plus two or more gadolinium-enhancing lesions.

Yes, a piece of research that could lead to a change in treatment protocols — not just “finding” what people with MS already know.

Early Disease Activity in MS Seen to Have Little Long-Term, Prognostic Value

Really? Early MRI scans that enable MS to be diagnosed are no real use in predicting how the disease will develop in any individual patient. Who’d have thought it? Maybe that could be the reason why many patients have regular scans over years of treatment.

A large study of multiple sclerosis patients came to the conclusion that clinical and brain imaging assessments drawn from magnetic resonance imaging (MRI) scans are poor measures of long-term prognosis for patients.

The study, “Long-term evolution of multiple sclerosis disability in the treatment era,” published in the journal Annals of Neurology, also showed that a lack of disease activity in the immediate years following disease onset does not predict later outcomes, and questions the use of yearly MRI assessments and whether aggressive early treatment to halt disease activity can actually ensure lower disability over time.

Researchers at the University of California San Francisco followed 517 MS patients over time. The vast majority (91%) were followed for up to 10 years. The team wanted to determine if brain scans and clinical assessments could be used to set a prognosis of disability development.

Results showed that in patients with relapsing MS, disability level at study start, as measured by the Extended Disability Status Scale (EDSS), did not impact how the disease progressed over the following decade, and only 55.3% had a worse disability score at the study’s end. For patients with progressive MS forms, worsening occurred in 75% of the patients. Those with EDSS scores lower than 3 at study start all worsened during the 10-year period.

OK, some interesting data here but, overall, nothing new. In 2002, when I was diagnosed with MS, the MRI clearly showed “areas of inflammation,” but the neurologist could not give a real prognosis.

Tysabri’s Success in Impairing the Immune System in RRMS May Be Source of Its Problems

We may be closer to understanding why Tysabri is linked with reactivating PML in some MS patients.

Although Tysabri (natalizumab) is a highly effective in treating patients with relapsing-remitting multiple sclerosis (RRMS), some may develop progressive multifocal leukoencephalopathy (PML). According to a new study, this occurs because Tysabri impairs immune surveillance in the central nervous system and reactivates the latent John Cunningham polyomavirus (JCV).

The study, “Natalizumab Affects T-Cell Phenotype in Multiple Sclerosis: Implications for JCV Reactivation,” published in the journal PLOS One, was developed by researchers at Sapienza University in Italy.

Tysabri, an anti-CD49d humanized monoclonal antibody, is known to impair the migration of inflammatory cells into the central nervous system (CNS), leading to a significant decrease in relapses in RRMS patients. It is currently one of the most effective therapies against RRMS, but reactivation of JCV — with consequent development of PML — often limits its use.

Currently, standard of care for RRMS patients includes the routine measurement of anti-JCV antibodies in the serum to assess patients’ risk of developing PML. But some patients have JCV infections even without detectable antibody responses, suggesting that additional markers are required to better risk-stratify patients for PML.

To me — and this is just my personal reaction — the benefits of taking Tysabri are outweighed by the JCV risk. Others may disagree and I respect their opinions.

Brain Inflammation Countered by Neuronal Growth in Mouse Model of MS

This has the potential to be of great benefit to those MS patients who develop cognitive difficulties, including memory loss.

As inflammation and neuronal death progressed in the brains of mice with multiple sclerosis (MS), a molecular signaling pathway with a key player called Wnt was seen to come into action in brain areas crucial for memory production, triggering the formation of new neurons.

The findings, presented in the study “Activation of Wnt signaling promotes hippocampal neurogenesis in experimental autoimmune encephalomyelitis,” published in the journal Molecular Neurodegeneration, suggest that boosting Wnt signaling could counter the effects of brain inflammation, possibly preventing the advent of the memory and cognitive problems affecting many MS patients.

Scientists believe that as MS progresses continued neurodegeneration in the hippocampus — a brain region crucial for memory and learning — may contribute to the cognitive problems patients encounter.

Mice with experimental autoimmune encephalitis (EAE), used to model human MS processes, can tell us a lot about what is going on in the brain both during acute and chronic stages of the disease. Earlier analyses of EAE mouse brains showed that genes involved in making new neurons were activated — a somewhat counterintuitive finding since we mostly associate MS with nerve cell damage and death.

New neurons being formed is undoubtedly an exciting development.

Improving Confidence of RRMS Patients May Enhance Quality of Life, Decrease Depression, Study Finds

How often do we hear of people recovering from serious illness or overcoming serious injury because of their own determination? People, who doctors say will never walk again, do exactly that and more! This is all about confidence and those of us with MS need it, too.

Increasing a person’s confidence that they can complete tasks and reach goals in specific situations may benefit patients with relapsing-remitting multiple sclerosis (RRMS).

In a new study, researchers used an intensive three-day social cognitive treatment, called Can Do, to increase patients’ self-efficacy, which resulted in long-lasting improvements in their health-related quality of life (HRQoL).

The study, “Intensive social cognitive treatment (can do treatment) with participation of support partners in persons with relapsing remitting multiple sclerosis: observation of improved self-efficacy, quality of life, anxiety and depression 1 year later,” was published in BMC Research Notes.

Self-efficacy is a psychological concept that is known to affect people’s behavior in a number of ways. Believing in our ability to perform certain tasks or to reach certain objectives determines how we deal with the difficulties of such tasks. Specifically, a person tends to avoid tasks where self-efficacy is low, and is more likely to feel discouraged and to give up when performing them as they believe the task is harder than it actually is, which may also be associated with increased stress. People with high self-efficacy tend to undertake tasks and persist longer.

In patients with chronic diseases such as multiple sclerosis, increasing disability affects patients’ independence, which in turn affects their self-efficacy. In such patients, a decrease in self-efficacy is correlated with a reduction in physical activity, as well as a reduction in physical and mental quality of life. Patients with lower self-efficacy are, therefore, more likely to experience depression.

Depression is one thing I have, so far, been fortunate to avoid because I am a confident person. I also choose to concentrate on what I can do, not what is now behind me. I would recommend that philosophy to everyone.

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 Services, and are intended to spark discussion about issues pertaining to Multiple Sclerosis.