Transcript
Susan Payrovi, MD: Okay, we’re excited to bring you some bonus material. And in this segment, we’re going to take some questions from our viewers.
“My sister has been on many (4) MS treatments, but her disease continues to progress. How can we tell which treatment is best for her?”
Mirla Avila, MD: So this will depend on which treatments she has been on and, um, also the age of the patient. And if we are considering, it seems like it may be now active secondary progressive MS because we’re realizing some progression despite disease-modifying therapy. So we may be in that point of that smoldering neuroinflammation and therapy that hopefully will be soon available in the pipeline.
But this will vary a lot, because if this patient has been on the old injectable DMTs, we still have a lot of other options to explore. So it’s difficult to answer the question without knowing the different disease-modifying therapies.
My best advice would be to talk with the neurologist, the health care provider, and try to explore if there is any of the highly efficacious DMTs that maybe your sister has not been on.
Susan Payrovi, MD: That question was from Susannah, so thank you so much for asking.
All right, next question comes from Becky M. She says:
“I was diagnosed with relapsing multiple sclerosis three days after my 50th birthday. I lost my eyesight with no notice due to optic neuritis. My neurologist started me on a drug called Ocrevus and said it would help lower the chance of my disease progressing. Is this sound advice, and should I get a second opinion? This is all so much to deal with at once.”
Mirla Avila, MD: Um, well, thank you for the question, Becky. And yes, this is good advice. So definitely, um, we are seeing more and more patients being diagnosed after the age of 50. Actually, here in our institution, we published this data just a few years ago. For some reason, we have a lot of patients diagnosed after that age.
And yes, we definitely would suggest to be on something, and medications — B-cell therapies such as Ocrevus and others that we have — do diminish the chance of progression and developing new symptoms. So I think I would agree with that. To be treated with something such as a B cell therapy can be a good option. It’s not the only therapy that you can have if you don’t tolerate it well, but it is a good option.
Susan Payrovi, MD: Great. Thank you, Becky, for that question.
Okay, our next question comes from Samantha C., who asks:
“I was diagnosed with early MS at 60. What percentage of people diagnosed with MS who receive aggressive treatment progress?”
Mirla Avila, MD: Um, thank you, Samantha, for your question. And I think this is a great question to have not only if you’re diagnosed older, but also if you have had MS for a while and you’re now in your 60s or more — Is your MS still going to be aggressive or not?
And there’s a concept that we call immunosenescence. That means that as we get older, our immune system also becomes less aggressive — meaning that it favors MS. It also favors opportunistic infection. That’s why when we’re older, we have to get the pneumonia shot and other things. And we’re more susceptible to cancers when we get older because our immune system becomes less aggressive.
The thing is that we don’t have a way to measure this right now. We can’t do a blood test and say, “Oh, you’re good. You’re in immunosenescence. You can relax. You don’t need to be on a therapy.” And then the immune system responds to triggers, and it can change. It can vary. So I have had patients in their 80s have a relapse because they had COVID, for example — something that triggered their immune system, because the immune system fluctuates.
Now, we do know that as we get older, usually we can use less aggressive medications because the immune system is less aggressive. But there still may be some variance among patients depending on your immune system.
Also, what I would suggest is that starting a therapy, keep close monitoring with MRIs, making sure you’re tolerating the therapy well. It may be after a while, if things are good, and you’re on a medication that has more risk by diminishing part of your immune system, you may consider going to a different one — if your doctor approves of that, depending on your scans, etc.
Susan Payrovi, MD: Okay. Thank you, Samantha, for that question.
And our next viewer question comes from Tim G., who says:
“I’m having a difficult time deciding on a treatment versus no treatment. If there is no cure, can I stay off treatment until I am showing signs that it is time?”
Mirla Avila, MD: Unfortunately, Tim, if we wait and once we have signs that it is time, we don’t have a way to repair that damage. So I would highly suggest to prevent damage before it occurs, since we don’t have a good way to repair — and especially because when we’re talking about damage, we’re talking about our spinal cord, our brain — that can lead to disability. So I would definitely recommend being on a therapy to prevent this.
Mirla Avila, MD: Well, that sounds like good advice. That wraps up our questions. Thanks again for watching. Just remember to always reach out to your health care providers with any changes to your health care plan.
