New research suggests that starting treatment for Multiple Sclerosis before symptoms appear could delay the onset.
The preliminary results of a small phase 3 clinical trial revealed that a drug named teriflunomide could delay or prevent MS in patients with radiologically isolated symptoms, which cause the same brain and spine cord lesions as people with MS. The findings will also be presented at the 75th Annual Meeting of the American Academy of Neurology in Boston next week.
Around half of those with RIS develop MS.
The goal of treatment during the RIS phase, according to Dr. Orhun Kantiri, a neurologist from the Mayo Clinic, Rochester, Minnesota and co-author on the new study, is to stop the disease before it becomes symptomatic.
There are currently no Food and Drug Administration-approved treatments for RIS, but early intervention is crucial, experts say.
We can’t undo the damage once it starts. It’s important to stop it before it starts.
MS is a central nerve system disease that affects the brain and spine cord. According to the National Institutes of Health, MS can cause symptoms ranging in severity. These include vision problems, muscle weakness and numbness, as well as difficulty concentrating.
Dr. William Shaffer said that people with RIS can have subtle symptoms which go unnoticed. He is a neurologist from UCHealth Fort Collins in Colorado and was not involved in this trial. He said that early treatment can prevent progression of the disease as soon as lesions have been detected.
It is approved for the treatment of patients with relapsing remitting MS, the most common form of MS. It is responsible for 85 percent of all cases. Sanofi, the company that makes the drug in question, funded the trial.
This is the second trial to see if an approved MS drug can prevent symptoms for people with RIS. The Arize trial evaluated another MS drug called Tecfidera in 87 patients in the U.S., and found that it was effective in delaying or preventing MS.
In the latest study, 89 adults with an average age between 40 and 50 years were studied for two consecutive years. 70% of the participants were women, with RIS lesions visible on an MRI. However, none of them had MS symptoms.
Comparing those treated with teriflunomide to those given a placebo showed a 63% lower risk of developing MS early symptoms, such as tingling, numbness, and balance issues or dizziness.
Cohen stated that “the medications seem to be more effective when started earlier.”
Kantarci noted that the two-year trial was in line with the length of time drugs are tested for MS clinical trials, and the results still indicate long-term effects.
Who is at risk for MS and should be treated early?
Kantarci explained that while early intervention may be expected for other diseases, like breast or colorectal tumors, which can be detected on scans even before symptoms appear, this is not the case with MS.
Unlike breast and colorectal, RIS is not screened. It’s usually discovered incidentally during a brain or spine MRI. Kantarci does not think this should change. RIS, which is rare, doesn’t warrant routine testing.
Early treatment is not recommended for the other half, as only half of RIS patients develop MS.
The Multiple Sclerosis and Neuroimmunology Centre at Cedars-Sinai, Los Angeles, is led by Dr. Nancy Sicotte.
Early intervention is a key component of RIS. A better understanding could guide doctors in determining which patients will benefit the most.
In previous research, certain lesions have been identified in RIS patients which may indicate that a person is likely to develop MS. Sicotte suggested that early intervention could be reserved in the future for these patients.
He said that based on past studies, “we now know that certain patients are more susceptible to MS symptoms, such as those who are younger, or have spinal fluid and spinal cord problems that suggest MS.” “We would like to see those who are most likely to develop symptoms of MS receive treatment.”
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