Treatment future brighter
For the many Canadians coping with MS, the last two decades have seen significant gains in treatment — and that landscape is expected to keep improving.
Canada has one of the highest prevalence rates of multiple sclerosis (MS) in the world. Each person experiences disease onset and progression in a different way. It is a disease of degrees with many complexities.
The treatment landscape for those diagnosed with MS has come a long way in the past two decades. In 1998 there were only three disease-modifying therapies for relapsing-remitting MS (RRMS), or episodic, form of the disease. Today, there are more than a dozen therapies. What’s more, the first drug for early primary-progressive MS (PPMS) received conditional approval in 2017.
Progressive MS is made up of two forms: secondary-progressive (SPMS) and PPMS. SPMS often follows the initial relapsing-remitting phase of the disease. PPMS, which affects about 15 per cent of people with MS, exhibits a gradual worsening of disability over time without defined relapses. This leads to unpredictability in how a specific person’s MS will be managed throughout their life and the impact it will have.
“We have made an enormous amount of progress in a short time,” says Dr. Pamela Valentine, president and CEO of the MS Society of Canada. “The next 20 years are expected to be fruitful in delivering additional effective therapies, especially those targeted to progressive MS, provided we continue to invest in research.
“There is limited understanding of why some people develop the progressive forms of MS,” says Dr. Valentine. “Treatment solutions are difficult to find when the underlying mechanisms of the disease aren’t fully understood.”
While one drug is now conditionally approved as treatment for early primary-progressive MS, and others are being developed for secondary-progressive MS, they are not enough. That is why, in 2012, MS societies from Canada, Italy, Netherlands, U.K., U.S.A. and MS International Federation formed the International Progressive MS Alliance. The alliance includes patients, clinicians, researchers and pharmaceutical companies from around the world.
In its first four years the alliance built a co-ordinated strategy to help fill the progressive MS treatment pipeline. Today, it has moved forward from that strategy and now has three collaborative teams working directly on finding solutions. Two teams are focused on drug discovery. The third, led by Dr. Doug Arnold at Montreal Neurological Institute at McGill University in Montreal, is looking at magnetic resonance imaging (MRI) data to determine if there are markers that indicate progression of the disease.
In addition to its work with the alliance, the MS Society recently provided $5 million to support a first-ofits-kind clinical trial to study the effects of cognitive and physical rehabilitation for patients with progressive MS. The study is being led by Dr. Anthony Feinstein, a neuropsychiatrist from the University of Toronto and Sunnybrook Health Sciences Centre. This international, multi-centre, six-country trial will treat 360 people with progressive MS over the course of 12 weeks. A subset of 120 patients will undergo MRIs to determine if cognitive improvement is linked to changes in the brain, such as atrophy. This is the first time such an ambitious study has been undertaken, given its large sample size and breadth across geography, cultures and languages.
This is a collaborative endeavor in every aspect. “I may be the quarterback, but we are working with worldrenowned MS researchers including neurologists, kinesiologists and psychologists, among others,” notes Dr. Feinstein. “With a study of this size, if results are positive we will have a high degree of confidence that our findings are meaningful.”
This is not a drug study, Dr. Feinstein emphasizes. “Our focus is improving symptoms and thereby, quality of life. Primary to that is cognitive ability because there is a high rate of impairment in progressive MS patients (up to 70 per cent). It is also an essential aspect of day-to-day functioning.”
The ability to use rehabilitation so people with progressive MS can live a better life is critical, adds Dr. Valentine. “Investing in research brings better understanding of the mechanisms of MS. This will help mitigate the impacts of an illness that affects patients — and those around them — over a lifetime. Ultimately, we are looking for a cure. In the interim this important study, and the work of the alliance and our many other partners, may bring answers now, while we continue our march toward the finish line.”
INVESTING IN RESEARCH BRINGS BETTER UNDERSTANDING OF THE MECHANISMS OF MS. THIS WILL HELP MITIGATE THE IMPACTS OF AN ILLNESS THAT AFFECTS PATIENTS — AND THOSE AROUND THEM — OVER A LIFETIME. ULTIMATELY, WE ARE LOOKING FOR A CURE. — DR. PAMELA VALENTINE, PRESIDENT/CEO, MS SOCIETY OF CANADA
THE NEXT 20 YEARS ARE EXPECTED TO BE FRUITFUL IN DELIVERING ADDITIONAL EFFECTIVE THERAPIES.