MULTIPLE SCLEROSIS TREATMENTS

The three major drugs previously approved for the treatment of MS affect the course of the disease. None of these drugs is a cure, but they can slow disease progression in many patients. Known as the ABC drugs, Avonex and Betaseron are forms of the immune system protein beta interferon, while Copaxone is glatiramer acetate (formerly called copolymer-1). All three have been shown to reduce the rate of relapses in the relapsing-remitting form of MS. Different measurements from clinical trials have demonstrated other benefits as well: Avonex may slow the progress of physical impairment; Betaseron may reduce the severity of symptoms; and Copaxone may decrease disability. All three drugs are administered by injection.

Two major clinical studies were recently completed that focused on the question of whether disease-modifying therapy known to slow the disease, can postpone the development of clinically definitive MS in high-risk patients. Data presented at the annual meeting of the American Academy of Neurology in May 2000, highlighted the different effects of interferon therapy when it was initiated at the earliest recognizable stages of MS. Previous studies with interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) clearly demonstrated benefits in patients with relapsing forms of MS.

In March 2002, Rebif was approved by the Federal Drug Administration (FDA) for use in the United States. During testing, Rebif performed better than Avon -- eliminating relapse in 75% of patients studied during the initial 24-weeks of the trial. Compared to 63% success rate with Avonex users during the same 24-week period, Rebif maintained its higher success rate over Avonex with 62% remaining relapse free after 48 weeks. Avonex success rate after a 48-week period was 52%. Elimination of relapse over an extended period of time is most beneficial for patients suffering from relapsing MS because with each relapse a significant quality of life is lost during the affected period. Serona S.A. (SRA) is the manufacturer of Rebif.

Although the ABC drugs stop relapses and may keep patients in relatively good health for the short-term, their long-term success has not been proven and they don't work well for patients who have reached a steadily progressive stage of MS. In the meantime, new approaches to using current therapies are being researched especially using combinations of different types of agents when one agent alone is not effective. Clinical trials are now evaluating the safety and efficacy of combining cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) in patients who do not respond to the ABC drugs, and of adding mitoxantrone (Novantrone), prednisone (Prelone), azathioprine (Imuran), or methotrexate (Rheumatrex) to beta-interferon for further benefit.

In addition, Miloxzantrone HCI (novantrone), a drug approved for cancer treatment, has been approved for treating patients with advanced or chronic multiple sclerosis. In clinical trials, mitoxantrone reduced the number of relapse episodes and slowed down the disease. Reserved for progressive forms of MS, it is given intravenously by a doctor to help maintain mobility and reduce the number of flare-ups. However, there are serious side effects with the drug, including heart problems, nausea, and hair thinning.

As reported in the Spring 2001 issue of InsideMS, the FDA approved the Copaxone Autoject and the Mixject vial adapters to help people using Copaxone self administer the drug. The autoject keeps the syringe steady and hides the needle. The same syringe may be used for both mixing and injecting with the Mixject vial adapters. A similar device is available for patients using Betassseron. Some patients are using the needle-free Biojector 2000, which uses a cartridge to deliver doses of medication through the skin. The FDA has not approved its use and patients should discuss this with their physician for its use with either Copaxone or Betaseron. Avonex must be injected in the muscle.

Immunosuppressant drugs have been used for many years to treat acute exacerbations (relapses). Drugs used include corticosteroids such as prednisone and methylprednisone; the hormone adrenocorticotropic hormone (ACTH); and azathioprine. Recent studies indicate that several days of intravenous methylprednisone may be more effective than other immunosuppressant treatments for acute symptoms. This treatment may require hospitalization.

MS causes a large variety of symptoms, and the treatments for these are equally diverse. Most symptoms can be treated and complications avoided with good care and attention from medical professionals. Good health and nutrition remain important preventive measures. Vaccination against influenza can prevent respiratory complications, and contrary to earlier concerns, is not associated with worsening of symptoms. Preventing complications such as pneumonia, bed sores, injuries from falls, or urinary infection requires attention to the primary problems which may cause them. Shortened life spans with MS are almost always due to complications rather than primary symptoms themselves.

Physical therapy helps the person with MS to strengthen and retrain affected muscles; to maintain range of motion to prevent muscle stiffening; to learn to use such assistive devices as canes and walkers; and to learn safer and more energy-efficient ways of moving, sitting, and transferring. Exercise and stretching programs are usually designed by the physical therapist and taught to the patient and caregivers for use at home. Exercise is an important part of maintaining function for the person with MS. Swimming is often recommended, not only for its low-impact workout, but also because it allows strenuous activity without overheating.

Occupational therapy helps the person with MS adapt to her environment and adapt the environment to her. The occupational therapist suggests alternate strategies and assistive devices for such daily activities as dressing, feeding, and washing, and evaluates the home and work environment for safety and efficiency improvements that may be made.

Training in bowel and bladder care may be needed to prevent or compensate for incontinence. If the urge to urinate becomes great before the bladder is full, some drugs may be helpful, including propantheline bromide (Probanthine), oxybutynin chloride (Ditropan), or imipramine (Tofranil). Baclofen (Lioresal) may relax the sphincter muscle, allowing full emptying. Intermittent catheterization is effective in controlling bladder dysfunction. In this technique, a catheter is used to periodically empty the bladder.

Spasticity can be treated with oral medications, including baclofen and diazepam (Valium), or by injection with botulinum toxin (Botox). Spasticity relief may also bring relief from chronic pain. Other more acute types of pain may respond to carbamazepine (Tegretol) or diphenylhydantoin (Dilantin). Low back pain is common from increased use of the back muscles to compensate for weakened legs. Physical therapy and over-the-counter pain relievers may help.

Fatigue may be partially avoidable with changes in the daily routine to allow more frequent rests. Amantadine (Symmetrel) and pemoline (Cylert) may improve alertness and lessen fatigue. Visual disturbances often respond to corticosteroids. Other symptoms that may be treated with drugs include seizures, vertigo, and tremor.

Myloral, an oral preparation of bovine myelin, has recently been tested in clinical trials for its effectiveness in reducing the frequency and severity of relapses. Preliminary data indicate no difference between it and placebo.

Bee venom has been suggested as a treatment for MS, but no studies or objective reports support this claim.

In British studies, marijuana has been shown to have variable effects on the symptoms of MS. Improvements have been documented for tremor, pain, and spasticity, and worsening for posture and balance. Side effects have included weakness, dizziness, relaxation, and loss of coordination, as well as euphoria.

Some studies support the value of high doses of vitamins, minerals, and other dietary supplements for controlling disease progression or improving symptoms. Alpha-linoleic and linoleic acids, as well as selenium and vitamin E, have shown effectiveness in the treatment of MS. The selenium and vitamin E act as antioxidants. In addition, the Swank diet (low in saturated fats), maintained over a long period of time, may retard the disease process.

Removal of mercury fillings has been touted as a possible cure, but is of no proven benefit.

Studies have also shown that t'ai chi can be an effective therapy for MS because it works to improve balance and increase strength.

There are conflicting views about Echinacea and its benefit to MS. Some medicine books recommend Echinacea for people with MS. However, Echinacea appears to stimulate different parts of the immune system, particularly immune cells known as macrophages. In MS, these cells are very active already and further stimulation could worsen the disease.

In a recent study conducted at the University of California, San Diego, MS patients taking 240mg of ginkgo biloba daily over a six-month period noticed an increase in memory and attentiveness. Patients involved in the study suffered from a mild form of multiple sclerosis, but were experiencing such typical cognitive symptoms as memory loss and lack of concentration. Positive results were measured against a control group taking a placebo during the same six-month duration as the gingko biloba test group.