One of the greatest recent accomplishments in neurology has been the explosion of research in Multiple Sclerosis. The biggest annual meeting for MS takes place in Europe and is called ECTRIMS (European Committee for Treatment and Research in Multiple Sclerosis). The research presentations are a mix of lectures and posters. There were the usual symposia by the big pharmaceutical companies presenting data supporting their disease modifying medications one monthly infusion for , there were preliminary presentations on new forms of therapy for relapsing-remitting MS, such as oral medications, monoclonal antibodies, and therapeutic vaccines. This is very exciting, because before 1993 there were no FDA approved medications for MS, now there are four injectable medications approved for relapsing-remitting MSrelapsing MS and one infusion for worsening or secondary-progressive MS (Novantrone or Mitoxantrone).
As you probably know, there are still no medications FDA approved for primary-progressive MS, but hopefully with newer research this will change in the next few years. Next year at the American Academy of Neurology Annual Meeting in Chicago we will hear about the results of Rituximab (Rituxan) in primary-progressive MS. Rituximab is a monoclonal antibody to CD20, which means that giving this IV medication will reduce B cells. When discussing the immunology of MS, we usually talk about T cells a lot, but we are learning more about how B cells (they make antibodies, which bind usually to "foreign invaders") are important in MS as well, and especially in progressive MS. Rituximab is being studied in relapsing-remitting MS and neuromyelitis optica (Devic's disease) as well.
As you probably know, we are finally entering the era of oral medicines for MS, but it will still be a number of years before these medicines are available outside of clinical trials. One of the oral medicines being studied is called FTY720 (Fingolimod), and the exciting news is that hopefully we will start studying it not only in relapsing-remitting MS, but in primary-progressive MS as well. It would be exciting to have one medicine for both relapsing and progressive MS.
While there is so much hope with all these new advances, I think we also have to be careful in ensuring that our new medicines are safe. One of the great things about the injectable medicines is that they are safe over the long-term, with the newer medicines (oral and monoclonal antibodies) we are seeing side effects that raise some concerns, like the development of other autoimmune diseases, infections, and potentially cancers.
So, how are we going to treat MS in the future? MS patients are all unique, and that's what makes it great to be an MS doctor. It's also what makes it tough sometimes. Eventually we hope to have a blood test where we could know what medicine is going to be right for a specific individual. This will probably be a "genomics" blood test - which will tell us doctors the specific gene expression of an individual patient's MS - and also what medicine makes sense to treat that individual with.