By Jerry Wolinsky, MD
While no treatment stops or reverses progressive MS, there are some that may slow down secondary-progressive MS. Symptomatic therapies may also help people adapt.
Let’s start with the distinction between primary-progressive and secondary-progressive MS. Primary-progressive slowly worsens from the start. People who have it almost never have attacks. Secondary-progressive occurs after a person has had attacks and remissions for some time, but then begins to accumulate permanent losses.
Treating secondary-progressive MS
There is evidence that our disease-modifying drugs, particularly Rebif®, Betaseron® and Avonex®, have some impact on slowing down secondary-progressive MS.
But that phrase, “slowing down,” never satisfies people, and why should it? “Slowing progression” means we see that the rates of accumulating problems are lower in the group that received active treatment in a clinical trial.
What we want is a treatment that stops progression, and ideally a treatment that reverses progression. We’re not there yet. Here is a rundown of current treatments.
- Disease-modifying drugs
The disease-modifying drugs regulate the immune system in a way that appears to correct some of the abnormalities that may be fundamental to MS progression. I think of it as changing the conductor to make an orchestra sound better.
- Chemotherapy drugs
Chemotherapy drugs can also slow down progression. Novantrone® is one of them, and while it has a lifetime dose limit to avoid heart damage, it is an effective option in secondary-progressive MS. In general, the chemotherapy drugs are not as targeted as the disease modifiers. Chemotherapy is more like firing the whole orchestra and hoping that management hires new players who won’t make the same mistakes.
Some physicians have used plasmapheresis for secondary-progressive MS, with mixed results. There is little evidence to support its use in either primary-progressive or secondary-progressive MS. In plasmapheresis, the plasma, or liquid component of blood, is removed and replaced with an artificial plasma. It may help because this removes all the immunoglobulins and other immune substances that are suspended in plasma. This treatment is generally reserved for people with severe, acute MS attacks that don’t respond to intravenous steroids.
- Bone marrow transplantation, also called “autologous stem-cell transplantation”
Bone marrow transplantation is a lifesaving treatment for certain cancers, especially leukemias. In bone marrow transplantations, people are given infusions of their own bone marrow, which was first extracted and treated. Chemotherapy and sometimes whole-body radiation are used to wipe out the person’s immune system before their treated bone marrow is given back. It has produced some good results in MS, usually for younger, less disabled people. But others have seen their MS return, and more progression. And, sadly, a few have died.
Treating primary-progressive MS
The news is more discouraging for primary-progressive MS. So far, we don’t have a treatment that has shown convincing evidence of slowing the accumulation of disability for people in this group. This form of MS progresses very slowly. Unless a drug has a truly major effect, good results may not show up in a two- or three-year study. The trials may not have been long enough or included enough people.
For up-to-date information on new treatments and clinical trials, talk to your physician and visit Research, Clinical Trials.
We have many therapies for MS symptoms such as spasticity, pain, speech problems, fatigue and more. People can do better with what they’ve got by using adaptive equipment. Symptomatic therapies don’t change the course of the MS.
But they make a major difference in people’s lives.