Dr. Arun Sharma

Update on Treatment of Multiple sclerosis in Dubai

Just 20 years ago, there was no treatment available for multiple sclerosis. With passage of time,and propelled by accumulated suffering of millions of patients and their family members medical research has built momentum, and consequent emergence of innovative therapies.

Multiple sclerosis (MS) is a potentially disabling disease that affects the brain and spinal cord. Approximately 2.1 million individuals have the condition worldwide.

The precise factors that cause and perpetuate MS are not entirely understood. Multiple sclerosis is an autoimmune disease that attacks the myelin sheath , the protective layer surrounding the nerves that help electrical signals to travel inside the brain and from the brain to the rest of the body through spinal cord.

Over time, the disease can and does permanently damage the nerve fibres in the brain and spinal cord. Symptoms tend to vary depending on the nerves affected and the damage caused.Loss of visio,initially temporarily and later permanently, numbness and weakness in any part of the body, inability to walk, staggering of gait ,tremors are some of the symptoms of Multiple sclerosis. When anyone experience these symptom,all of a sudden ,visit me in person or visit my website www.bestneurologistdubai.com

Medications recently approved by the Food and Drug Authority of USA

At present, disease-modifying therapies (DMTs) are the best strategy to slow the course of MS. DMTs reduce the frequency and severity of relapses - or attacks and exacerbations - and the development of new lesions, and slow down the progression of disability.

The number of available DMTs has increased rapidly in recent years, and at the time of writing this article there are at least 15 of them that are approved by the U.S. Food and Drug Administration (FDA) for relapsing forms of MS, including relapsing-remitting MS (RRMS). One of these is also the first to be approved for use in primary progressive MS (PPMS), and the FDA has approved another for use in secondary progressive MS (SPMS).

Ocrelizumab

The FDA approved a revolutionary new drug in 2017 for the treatment of remitting-relapsing MS (RRMS). The drug is also the first approved to treat PPMS. Research conducted by a team of researchers has shown that ocrelizumab significantly reduces relapses in RRMS and slows down the progression of symptoms in PPMS.

Ocrelizumab, as with many other MS treatments, is an immunosuppressant drug. While most drugs for MS target T cells, ocrelizumab targets a subset of B cells that are thought to play a role in the destruction of myelin. Phase III clinical trials for RRMS indicated that compared with interferon beta-1a, ocrelizumab was able to reduce relapse rates by up to 47 percent, cut back disability by up to 43 percent, and decreased inflammatory lesions in the brain by 95 percent. Patients receiving ocrelizumab not only had fewer new brain lesions and less loss of brain volume than the placebo group.

Latest innovations in the MS drug pipeline

The development of new medicines can take 10 to 15 years from the test tube to the pharmacy shelf. For every 10,000 compounds tested, fewer than one or two become licensed treatments, with many rejected on the grounds of their safety, quality, or lack of efficacy. Some therapies in their final phase of clinical trials are listed below. If the drugs prove effective in this phase, data from phases I through III are presented to the FDA for approval. Only 25 to 30 percent of drugs progress to the next stage following FDA approval.

Laquinimod

Laquinimod is an experimental drug in phase III trials for relapsing RRMS, and phase II trials for PPMS. Laquinimod may prevent immune cells from reaching the brain. Investigations have indicated that Laquinimod has both anti-inflammatory and neuroprotective actions. Phase III studies of Laquinimod have shown a 23 percent reduction in annual relapse rate compared with a placebo, a 33 percent decrease in disability progression, and a 44 percent reduction in brain volume loss.

AHSCT

The idea behind autologous hematopoietic stem cell transplantation (AHSCT) is to "reboot" the immune system in people with MS. Hematopoietic, or blood cell-producing, stems cells derived from the person's own (autologous) blood or bone marrow are collected and stored.

After chemotherapy drugs are used to deplete much of the immune system, the stored stem cells are then reintroduced to the body, and the new cells make their way to the bone marrow and gradually rebuild the immune system within 3 to 6 months.

Imperial College London in the United Kingdom recently published the long-term outcomes of AHSCT in people with relapsing MS. They revealed that AHSCT might halt the symptoms of the disease from progressing for 5 years in 46 percent of MS patients. However, the treatment carries significant risk due to the involvement of aggressive chemotherapy.

MD1003

MD1003 (high-dose biotin) is being tested in phase III trials for primary and secondary progressive MS. The drug is a highly concentrated form of biotin - 10,000 times the recommended daily intake - that activates enzymes involved in cell growth and myelin production. High doses of biotin may promote myelin repair. Investigators compared MD1003 with a placebo in primary and secondary progressive MS. They found that 13 percent of individuals in the MD1003 group improved in disability after 9 months compared with no improvement in the placebo group.

Siponimod

Siponimod is being developed for use in Secondary Progressive MS (SPMS). The drug works by coralling T cells and B cells in the body's lymph nodes and spleen, which prevents them from entering the brain and spinal cord and causing harm to myelin sheath of nerve fibres. In a phase III trial, siponimod was found to lower the risk of disability progression by 21 percent at 3 months of treatment and 26 percent at 6 months compared with a placebo. The drug was also shown to reduce the number of relapses experienced and brain shrinkage, or atrophy.

Antioxidant

An over-the-counter antioxidant called lipoic acid may prove valuable in the treatment of SPMS, according to researchers from the Oregon Health & Science University in Portland. Their study revealed a 68 percent improvement when using lipoic acid compared with a placebo in slowing the rate of whole brain atrophy. As a comparison, the recently approved ocrelizumab showed an 18 percent improvement over placebo in slowing the rate of whole brain atrophy in primary progressive forms of MS.

Gut microbes : Bugs as Drugs

Researchers from the Mayo Clinic in Rochester, MN, have reported that a human gut microbe called Prevotellahisticola suppressed MS in mice. It decreased the levels of pro-inflammatory cells .

Is a cure for MS imminent?

As yet, there is no cure for MS. However, we are going through a revolutionary epoch of time wherein researchers are making significant progress and breakthrough solutions toward defeating MS. Today, more therapies for MS are in development than ever before, and the disease is being diagnosed at a quicker rate, enabling early treatment to slow disease activity. There is greater awareness of all the associated symptoms of MS and how to manage them to improve life quality. For a more in depth knowledge of latest treatment of Multiple Sclerosis (MS) in Dubai please visit me in person or visit my website www.bestneurologistdubai.com