Possible combination treatment approaches to tackle MS
Neurology Doctors’ knowledge of the type and causes multiple sclerosis is leading to new potential for treatment and research, according to a leading University of Cambridge expert.
MS comes in two forms: the relapsing-remitting form and a progressive form. Around 80% of people who have MS have the relapsing-remitting form, and have periodic flare-ups of symptoms that affect their nervous system. The other 20% have progressive forms of MS, which cause a slow and gradual loss of their ability to do things.
The two different forms have different causes. Although we still don’t fully understand these differences, it appears that – put simply – the relapsing-remitting form is caused by inflammation in the brain, whereas the progressive form is caused by the slow damage and then death of nerves. This happens when a protective coat of a substance called myelin which normally protects the nerves from damage, is lost.
“In the last 20 years we have made really good strides with relapsing-remitting MS, but not for progressive MS, and the reason why is linked to their different causes”, says Dr Alisdair Coles, senior lecturer in the department of clinical neurosciences at the University of Cambridge. “But we do have an advantage, because the two forms of MS aren’t entirely connected. This means we can adopt two approaches: early treatment and experimental approaches.”
Early and aggressive treatments for relapsing-remitting MS means using the strongest drugs as soon as people are diagnosed. This approach is controversial and there’s a genuine lack of consensus about whether it is safe. But the National Institute for Health and Care Excellence, which published guidance on how to treat MS in October 2014, is that people can be treated with stronger drugs even if they have early MS.
Coles says: “We can use early and aggressive treatment to stop people’s nerves from being stripped of their myelin. It’s still not standard treatment and the conservative position, which I understand, is to use milder drugs for people early on in the disease. At the moment there’s little evidence to say that this approach stops the progression of MS over the long-term, but that’s because we have not had the drugs for very long.”
Another approach would be to look at the possible potential of giving people with MS drugs that can restore the myelin that damaged nerve cells have lost. “There’s promising lines of research, although nothing yet that’s in the clinic”, Coles says.
“We know there are stem cells in the brain that are capable of being remyelinated. So the challenge is to wake up the cells that that otherwise just sitting there dormant” says Cole, who is conducting an early-stage trial looking at using existing MS drugs in this way.
So the current research efforts in MS mean that in the future people with MS could benefit from a combination approach, to combat the inflammation and to regenerate stem cells and repair the nerves – and possibly leading to better management of MS.