New Hope for Progressive Forms of MS

A frustration for many with progressive forms of MS is the lack of approved treatments and, until recently, the lack of research for new medications to treat progressive MS. However, there are now many clinical trials investigating the use of current medications, medications approved for other diseases, and new medications and procedures that specifically target the immune system cells thought to be involved with MS progression.

What is Progressive MS?

Multiple sclerosis is an autoimmune condition that affects the central nervous system – the brain and the spinal cord. In MS, the immune system becomes misguided and attacks cells and tissues in the central nervous system. Early in the disease, inflammation is a prominent feature, and it is common for some with MS to have episodes of symptoms, known as relapses or exacerbation. This is known as relapsing-remitting MS or RRMS.

Progressive MS, however, is characterized by the gradual worsening of symptoms and an increase in damage to the central nervous system over time. There are two main progressive forms of MS: primary progressive MS and secondary progressive MS. The main difference between the two is when progression begins.

Rather than experiencing episodes of symptoms at the start of diagnosis, those diagnosed with primary progressive MS have a disease course that gradually worsens from onset without discernable relapses. On the other hand, someone who is diagnosed with relapsing-remitting MS may eventually experience fewer new areas of inflammation (seen on an MRI) and fewer relapses – but there may be more accumulation of disease and worsening of symptoms over time. This is known as secondary progressive MS or SPMS. SPMS may be active (with some relapses and new MRI activity) or non-active, meaning with or without new relapses or new MRI activity.

More recently, researchers have better identified areas within the central nervous system where immune system activity is ongoing – often called a smoldering process – causing a greater accumulation of disease and worsening of symptoms over time. Their understanding explains why some people continue to feel worse or become more disabled even though the inflammation has been treated by a DMT and the MRI scan appears stable. This has led to looking at new treatment strategies to improve the long-term outcomes for people with progressive MS.

Progressive MS Treatment

All of the available FDA-approved MS disease-modifying therapies or DMTs are indicated for relapsing forms of MS – including active secondary progressive MS.  However, just one MS DMT is approved for primary progressive MS, and no specific MS DMTs exist for non-active secondary progressive MS. This does not mean that nothing can be done—that is far from the truth. Researchers are identifying new targets in the immune system and developing new medicines for people with progressive forms of MS. In fact, several are under study right now.

Clinical trials are currently underway and recruiting volunteers for treatments targeting progressive forms of MS.  Below are several of the medications under study:

• Currently available MS DMT’s – Many of the currently FDA-approved MS DMTs are under study for their impact on progressive forms of MS, including Mayzent® (siponimod), Mavenclad® (cladribine), and Ocrevus® (ocrelizumab)
• Oral treatments – Several oral medications are under study for the treatment of secondary progressive These include Bruton’s tyrosine kinase inhibitors, which target immune system cells in the periphery and in the central nervous system. Because of the activity of these medications in the central nervous system, it is believed that they may be helpful in progressive forms of MS. There are also studies of drugs approved for other indications, including diabetes medication, Metformin, and an antihistamine, Clemastine, for treatment of progressive MS which may enhance remyelination.

• CAR-T cell therapy – Chimeric Antigen Receptor T Cell therapy is a newer way of targeting the immune system in MS. Using the body’s own T-cells, researchers genetically engineer these cells in the lab to provide them with a very targeted receptor on their surface – known as a CAR (chimeric antigen receptor). This man-made receptor allows the T cell to rapidly and efficiently identify and eliminate specific immune system cells causing MS damage.

These clinical trials represent mechanisms of action that may target the immune system activity responsible for progressive forms of MS.  If you are interested in learning more about clinical trials for progressive MS, the first step is to talk about it with your MS provider. For more information on progressive MS and clinical trials,  please visit:

Bristol Myers Squibb – What is CAR-T Cell Treatment for Autoimmune Diseases?

Can Do MS – CAR T Cell Therapy

Can Do MS – Progressive MS 

ClinicalTrials.gov

As the future of progressive MS treatments improves, there are still actions you can take to manage your disease progression:

1. Currently available FDA-approved MS DMTs

The approved DMTs, although geared towards relapsing-remitting MS, may be effective for progressive forms of MS. While the current medications work best with active inflammation, there may be benefit in many with secondary progressive MS. Working with your MS care provider will help identify a treatment that may be right for you.

2. Rehabilitation

Physical rehabilitation has been effective for improving strength, flexibility, energy and endurance. Cognitive rehabilitation is helpful for many with slowed processing speed and short term memory impairment. If you are having mobility and/or cognitive challenges let your MS provider know so that appropriate referrals can be made.

3. Lifestyle

Exercise and physical activity have been found to improve endurance, energy, strength, and flexibility. In addition, exercise can enhance cognitive function and improve mood. This does not mean one must sweat it out at the gym. All physical activity counts and is beneficial. The recommendation for exercise is 150 minutes each week. Not all at once and not necessarily in a big chunk each day. Short periods of activity also count towards the 150 goal.

While significant unmet need exists for people with progressive forms of MS, there is new hope as researchers are identifying new targets and actively studying new treatments, medications, and procedures that may limit MS disease progression. And keep in mind that there are effective medications that can slow disease progression and many things that you can do that can enhance your functional abilities.