New Drugs for Multiple Sclerosis

After decades of basic research on Multiple Sclerosis, the past five years have brought a rapid rollout of new and sophisticated drugs that are changing how this disease is managed and offering patients new hope.Two of these news drugs are Tysabri and Ampyra.

"We have a disease that's gone from having no treatments 20 years ago to having multiple treatment options," said Dr Timothy Coetzee, the chief research officer at the National Multiple Sclerosis Society. "There is a growing recognition that MS is becoming a manageable disease." In MS, the body's immune system damages neurons in the brain and spinal cord, attacking the myelin sheath that insulates these nerves. About 85 percent of patients start out with what is called relapsing-remitting MS, charaterized by flare ups or attacks that cause lesions to form on the brain and that affect the ability to walk, to see and to control the bladder, among other neurolical impairments.

These attacks are short lived, and patients typically recover from them. But more than half of patients eventually develop a progressive form of MS, causing the permanent loss of these functions. Doctors can now choose from eight disease modifying drugs, which relapses and thereby slow the progression of the disease. Some of the drugs also prevent brain neurons from dying off, now thought to be a major cause of permanent disability. There have also been advances in treating specific symptoms of MS. Within the past two years, three medicines have been approved specifically for MS symptoms: Ampyra to improve walking, Nuedexta for uncontrollable laughing or crying, and botox for urinary incontinence and spasticity in upper limbs.

"We're shooting for disease free status, where someone with MS is on a medicine and has not sign of MS," said Dr. Richard Rudick, director of the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic. The first generation of MS drugs included mostly immune suppressing interferons delivered via injection or infusion. These are still the most widely used, reducing relapses by about one third. The new drugs are more sophisticated, targeting specific molecules involved in the disease, rather than simply tamping down the immune system to reduce inflammation in the brain.