New Treatment for Multiple Sclerosis May Halt Disease Progression

Highlights

• Multiple sclerosis is a central nervous system disorder which affects the brain and spinal cord.
• Resetting the immune system by Autologous Hematopoietic Stem Cell Transplantation (AHSCT) may halt the progression of multiple sclerosis in patients.
• The treatment is found to improve the worsening symptoms for five years after treatment.

A new type of multiple sclerosis treatments which involves resetting the immune system may halt the progression of the disease in most of the patients. The recent study led by Imperial College London prevented symptoms of the severe disease for a period of 5 years, in about 46% of the patients. Symptoms of multiple sclerosis may include fatigue, problems with arm and leg movement, vision and balance.

Multiple sclerosis is an autoimmune disease which affects the brain and spinal cord. Around 100,000 people in the United Kingdom and 2.3 million people in the world are affected by multiple sclerosis.

The patients with advanced form of multiple sclerosis who had failed to respond to other medications were given autologous hematopoietic stem cell transplantation (AHSCT).

The recent study was published in the journal JAMA Neurology, which may show small improvements in following the treatment.

The treatment may aim to prevent the immune system from attacking the nerve cells. These immune cells are made from the stem cells in the bone marrow. A patient is given a drug which encourages stem cells to move from the bone marrow to the blood stream and then cells are removed from the body.

A high-dose of chemotherapy received by the patient which further kills any immune cells. These stem cells are then transfused back to the body to re-grow their immune system.

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Previous studies have suggested that resetting the immune system may stop the progression of the disease by attacking the nerve cells.

Some patients were found to die due to infections as they received an aggressive chemotherapy which inactivates the immune system for a short period of time.

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Eight out of the 281 patients who received treatment, died after 100 days of the treatment. Older patients with severe form of the disease had a higher risk of death.

Dr Paolo Muraro, lead author of the study from the Department of Medicine at Imperial, explained that the risks must be weighed-up against the benefits, said, "We previously knew this treatment reboots or resets the immune system - and that it carried risks - but we didn't know how long the benefits lasted.

"In this study, which is the largest long-term follow-up study of this procedure, we've shown we can 'freeze' a patient's disease - and stop it from becoming worse, for up to five years.

However, we must take into account that the treatment carries a small risk of death, and this is a disease that is not immediately life-threatening."

The patients with multiple sclerosis often have a type of disease called flare-ups, which is referred to as relapsing-remitting multiple sclerosis.

Study Findings
The number of years that the treatment takes to halt the disease progression or prevent the symptoms from worsening can be far greater when compared to the untreated patients.

The study found that 73% of the patients who had relapsing multiple sclerosis, did not experience any worsening symptoms for five years after the treatment.

Younger patients who have a less severe form of the disease may more likely respond to treatment.

Since most of the patients in the study have a progressive form of multiple sclerosis, there is no treatment that is available currently. Among these patients, one out of three experienced no symptom worsening after five years of treatment.

Some of the patients may show a small improvement in their symptoms, these improvements were larger in patients with relapsing multiple sclerosis when compared to patients with a progressive form of the disease.

Expanded Disability Status Scale (EDSS)
The disability due to multiple sclerosis is assessed on a scale which is known Expanded Disability Status Scale (EDSS).

The scale reading zero represents no disability while a score of seven is wheelchair-bound and a score of 10 may represent death from multiple sclerosis. These patients had an EDSS score of 6.5 initially at the beginning of the study which was followed by a 0.76 improvement after one year in relapsing multiple sclerosis patients and only 0.14 improvement in progressive multiple sclerosis patients.

Encouraging Insights for Multiple Sclerosis Treatment
The author also adds that the findings of the study suggest for larger trials. "These findings are very promising - but crucially we didn't have a placebo group in this study, of patients who didn't receive the treatment. We urgently need more effective treatments for this devastating condition, and so a large randomized controlled trial of this treatment should be the next step."

Dr Sorrel Bickley, Head of Biomedical Research at the MS Society, added, that the study is one of the largest looking at AHSCT as treatment for multiple sclerosis as they are the findings offer encouraging insights. The treatment can either slow or stop progression for many years and the treatment is most effective for people with multiple sclerosis those who have ‘active inflammation’ in the brain and spinal cord.

Around 100,000 people in the United Kingdom have multiple sclerosis. The research funding by Multiple Sclerosis Society can develop further knowledge on the condition and find treatment for everyone.

"If anyone with MS is considering AHSCT they should speak to their neurologist as a referral is needed to access this treatment via a trial or on the NHS."



Source-Medindia