Alemtuzumab & MS

A few days ago (April 15th 2010), Medical News Today reported on the use of Alemtuzumab for the treatment of MS. The research in question reported that a significant percentage of MS patients who received Alemtuzumab remained free of clinically-active disease.

More precisely, 71% of the patients treated with alemtuzumab remain free of clinically-active disease as much as three years after most patients received their last course of the investigational compound. The data were presented at the American Academy of Neurology annual meeting.

This trial was compared Alemtuzumab to Rebif® (interferon beta-1a) in patients with early, active, and relapsing-remitting MS, who had received no prior therapy. For the details of the trial and more on the results visit the Medical News Today website link to the right ; )

What I think is important to highlight from this trial is that researchers believe Alemtuzumab to target the immune system cells responsible for the cellular damage (found in multiple sclerosis), while sparing other immune system elements.

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Groundbreaking MS research to be announced April 10-17th

From the Medical News Today website (article dated April 14th 2010, see under Links to the right)

At the American Academy of Neurology (AAN) Annual meeting, among other things, a potential new drug for the treatment of MS, and surprising trends showing a reduction in the disease’s severity…

Teriflunomide, is an investigational oral medication for relapsing-remitting multiple sclerosis (RRMS)… The study analyzed teriflunomide added to ongoing treatment with glatiramer acetate, a currently prescribed medication, and determined that teriflunomide was safe and effective as part of combination therapy.

And most important of all:

MRI studies revealed that teriflunomide also proved to be effective at reducing the size and volume of lesions on the brain.

“While our study was designed to evaluate the safety of teriflunomide, we determined that in addition to being safe it was also effective in reducing the size and number of lesions in people with RRMS,” said Aaron Miller, MD, Professor of Neurology, and Medical Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine.

“Further data are required to evaluate efficacy of this combination therapy, but the results are promising.”

One can just comment…that it really sounds like the data is promising! if this drug manages to REDUCE the size AND volume of lesions on the brain…wow!

Involuntary laughing or crying? – PBA & MS

Ever started laughing uncontrollably and for no reason?? It happened to me just a few weeks ago…I simply couldn’t stop…and now I just read an article in Medical News Today (14.04.2010) that talks about PBA – the pseudobulbar affect. Here, I gathered the most relevant things from the article:

Pseudobulbar affect (PBA) is a neurologic condition of involuntary, sudden and frequent episodes of laughing or crying and is quite common in patients with underlying neurologic diseases or injuries, especially those with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS).

A novel investigational treatment may help stop these involuntary outbursts, which might damage the MSers or ALSers social functioning and overall quality of life..

The study in patients diagnosed with PBA tested the effectiveness of a combination of two medications, dextromethorphan and low dose quinidine. The combination of the drugs is known as DMQ.

The study demonstrated improvements in the patients tested. The study’s author MD. PhD Pioro said that the findings “represent the first long-term results showing DMQ is effective in helping to control this debilitating condition afflicting patients with neurologic diseases or injuries“.

In addition, there are no FDA approved treatments for PBA. This makes it problematic for PBA affected patients as the currently used off-label treatments are often ineffective or may have unacceptable side-effects.

DNA blood tests to predict & monitor MS

On September 5th 2009 I reported about a test that could potentially not only predict the course of MS but also indicate who is likely to develop the condition after a first MS-like attack.

This article here (Medical News Today April 8th) talks about DNA blood tests that would predict the status & monitor disease activity and even the response to treatment in MS.

Chronix Biomedical uses proprietary technology to identify disease-specific genetic fingerprints based on the circulating DNA that is released into the bloodstream by damaged and dying cells. A growing body of publications from Chronix and other researchers shows that this circulating DNA can be identified and analyzed to provide a diagnostic window into ongoing changes in the genome associated with specific diseases-changes that can be used to track the presence or absence of active disease. This new study is the first to show that the Chronix approach can be used to monitor the clinical status of a chronic disease.

“These positive data further validate the premise underlying the Chronix approach, showing that the many genetic anomalies associated with active and stable relapsing-remitting MS can be detected by analyzing DNA fragments circulating in the blood serum,” said Mario Clerici, M.D., Chair of Immunology, Department of Biomedical Sciences and Technologies, University of Milano, Milan, Italy and a co-author of the study. “The prognostic value achieved in this study supports the ability of this new approach to help manage relapsing-remitting multiple sclerosis, potentially offering clinicians a new tool to easily assess which MS treatment options are most effective for their patients, as well as providing critical information that will facilitate development of the next generation of MS therapeutics”

Smoking & MS

On April 8th, Medical News Today reported (yet again) on a link between smoking & MS.. This new study shows that smoking may increase the risk of multiple sclerosis in people who also have specific established risk factors for MS.

….

The study also found that among those with high levels of the Epstein-Barr virus antibodies, smokers were twice as likely to have MS as those who had never smoked. The same association was not seen in those with low antibody levels. The risk of MS associated with smoking was not different in people with and without the HLA-DR15 gene.

The study’s author Claire Simon, ScD, with Harvard School of Public Health in Boston said that “the consistency of an association between MS, smoking and the body’s immune response to the Epstein-Barr virus based on these three distinct, geographically diverse studies suggests this finding is not due to chance.” In this way, reasons so as to why some people develop MS and others not may be apparent.

For the whole study, click on the Medical News Today link on the right ; )

Ampyra – dalfampridine – finally available! :)

In a previous post (January 27th 2010) titled “Ampyra – improves walking speed for MS patients!” I talked about the speedy approval that the FDA had given to dalfampridine. Dalfampridine is the first therapy for multiple sclerosis that can be taken orally (!!!!). It is also the first FDA-approved therapy to treat impaired walking, a debilitating symptom of the disease limiting patients’ independence and ability to accomplish the most basic tasks of daily living. While other multiple sclerosis drugs work by decreasing the inflammation that causes damage to the central nervous system, dalfampridine is designed to allow conduction of nerve impulses despite the damage.

The following paragraphs are taken from Medical News Today (April 6th, 2010). I am quoting them as I think they are well written and rather interesting as they give a short background story of the research including why this research is different from previous ones..:

Research that led to the discovery of dalfampridine’s therapeutic value dates back to the 1960s, when Dr. Floyd Davis, then a neurologist in training and later a physician at Rush, became intrigued by an unusual clinical observation: many multiple sclerosis patients fare better when their body temperature is slightly lowered, even by just two- or three-tenths of a degree.

“In multiple sclerosis, the protective myelin sheath that wraps around nerve fibers in the brain and spinal cord is damaged, essentially causing a short circuit,” said Davis, who is now retired. “Somehow, lower body temperature enabled the electrical pulse to continue its travel along the nerve fibers. I was completely transfixed by the significance of that fact.”

It was important because it showed “that the damaged nerve fibers were not doomed, as previously believed,” said Dr. Dusan Stefoski, director of the Rush Multiple Sclerosis Center, who teamed up with Davis in 1978, shortly after completing neurology training at Rush.

It makes sense to me now why heat isn’t a friend of mine anymore (and of many other MSers)…at least now there is some sort of connection/proof for it ; ) Also, I think the fact that the damaged nerve fibres are here no longer seen as irreversibly damaged creates a huge hope in all of us!

The drug is now available in the US! Hopefully it will soon come to Europe as well.

Reminder: throughout the various trials the drug yielded a consistent improvement in walking speed & the study participants who took the drug also experienced greater leg strength than those who took a placebo. One of the Doctors that teamed in the study, Dr. Stefoski, said that although the drug has been approved specifically for the treatment of impaired walking, it also relieves other symptoms of multiple sclerosis, since it restores signal conduction in all the affected nerve fibers. (!!!!)

For more details on the study see under “Links” to the right and click on “Medical News Today”.

Two types of MS = Two different responses to Beta-Interferon

Medical News Today (article first reported on March 29th)

The article in question mentions a Stanford study – the discovery of two types of MS, which are based on the two different responses that patients have to beta-interferon.

The study was conducted on both animal (animal model of MS – called experimental autoimmune encephalitis -EAE) and human blood samples. The patient’s responsiveness to interferon beta (the first-line drug given to MS patients) was seen as depending on the version of MS that the patient has.

These findings need to be confirmed in larger human studies and by other laboratories, and when that is done this would mean that MS patients some day might be able to take a simple blood test to see whether they are likely to respond to treatment with the standard multiple-sclerosis therapy, said senior study author Lawrence Steinman, MD, the George A. Zimmerman Professor of Neurology and Neurological Sciences at the Stanford University School of Medicine. He also added: “I think this has the potential to transform the way we take care of people with multiple sclerosis.” He said a simple, already available blood test could spare many patients the inconvenience and side effects – and spare the health-care system the expense – of a drug that most likely won’t do any good. “The other side of the coin is that beta-interferon, if it’s given only to those who are predisposed to respond to it, could turn out to be a far better drug than we ever imagined.”

Beta-interferon’s overall efficacy is only fair, he said, with perhaps half of all multiple-sclerosis patients experiencing an average one-third reduction in recurrences. Plus, its discomfiting side effects – flulike symptoms – can make compliance an issue for patients, especially given the drug’s iffy efficacy.

And just a final note: earlier work by Steinman, proceeding from animal models to clinical trials, led to the development of another blockbuster multiple-sclerosis drug, natalizumab, marketed under the trade name Tysabri (the treatment I’m currently on and so grateful for).