The complexity in underlying mechanisms, a lack of representative research models, and inconsistent criteria defining therapeutic benefit are the main reasons why an effective therapy for progressive forms of multiple sclerosis (MS) is still lacking, researchers maintain in a review study.
Nevertheless, as research continues to shed light on the root causes of the disease, scientists will move closer to finding targeted, effective treatments, the authors say.
The article, “Progressive multiple sclerosis: from pathophysiology to therapeutic strategies,” was published in the journal Nature Reviews Drug Discovery.
Although progress has been made in developing new therapies for relapsing-remitting MS (RRMS), treatment of progressive forms of MS — characterized by gradual accumulation of disability — without acute flares (relapses) or remissions, remains unsatisfactory.
Some patients experience progressive disease from the beginning of symptoms, referred to as primary progressive MS (PPMS), while others experience it as a later stage following RRMS, in which case it is called secondary progressive MS (SPMS).
In the review study, an international team of researchers, including doctors at St. Josef-Hospital, University Hospital at Ruhr-Universität Bochum (RUB), in Germany, and collaborators at the University of Calgary and the University of Alberta, Canada, joined to discuss how much is known about the mechanisms underlying progressive MS, and the potential treatments being explored. The setbacks encountered and future challenges also were discussed.
Emerging therapies in MS currently include those targeting inflammation and nerve cell death (neurodegeneration), as well as those promoting remyelination — that is, the repair of myelin, which is the fatty coating that surrounds and insulates nerve cells, and is destroyed in MS.
“A bottom line of our analysis is that the reason why it is so difficult to treat progressive MS is the fact that progression is caused by various mechanisms,” Simon Faissner, MD, said in a RUB press release written by Julia Weiler. Faissner is a professor at RUB and the study’s lead author.
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