This is part 2 of this month's research roundup, dealing with treatments. Part 1, dealing with risk factors, links with other conditions, diagnosis and symptoms, is here.
First of all, American researchers have found that exercise appears to protect the brains of people with MS. Yes I know, it makes me want to go and have a little lie down too! The statistics show though that participants with higher levels of fitness had greater cognitive power, higher levels of grey matter (which is linked to brain processing skills), and less damage in areas of the brain where MS deterioration occurs.
Now, call me a cynic (You're a cynic, FM!) but I'd like to see some long-term data on this one. Could it be that those with less brain damage etc were also those who were more able to do exercise? So therefore the causality is the other way round from what they're suggesting?
English researchers have been comparing an existing treatment, interferon beta 1-a, against a new treatment, Campath (alemtuzumab). They gave one or the other to people with early, active RRMS. After 3 years, over 70% of those on Campath were disease-free compared to over 40% of those on interferon. Over half of those on Campath found their level of disability lessened. Campath sounds like an extremely promising treatment.
While we're waiting to see if Campath and other treatments are approved or not, most people with RRMS remain on one or other of the self-injected medications. When someone is on interferon, and their disease suddenly becomes more active, it may be decided that they should go on a higher dose. Italian doctors researched whether going on to a higher dose was beneficial or not. In the majority of cases, they found that increasing the dose of interferon had no effect on number of relapses or disability progression. Where the switch was only on the basis of MRI activity, there was a lower risk of further relapses, but the researchers did not feel this merited a general increase based on MRIs, until more research is done.
disease modifying treatment for MS. British researchers used various clinical and MRI measurements to show that it was more effective in patients with RRMS than was a placebo. Around 45% of those taking cladribine were disease-free after 96 weeks, compared to 16% of those taking the placebo.
The European Medicines Agency has recommended against the licensing of cladribine, because it does not believe that the benefits outweigh the risks. There were some cancer cases during the trials, and the drug suppresses the immune system and makes the patient vulnerable to infections. The manufacturers, Merck Serono, are appealing against the decision.
Now two pieces of stem cell research.
One of the most difficult things in stem cell research is learning how to make a cell change from one thing to another. Our stem cells do this all the time, changing into all the many and varied tissues of our body. A group of American researchers have managed to change cells from a pre-implantation mouse embryo into epiblast cells, one of the types found in an embryo very soon after implantation.
A group of Greek researchers are following a different route. Called hemopoietic stem cell transplant, it involves taking bone marrow stem cells from the patient then transplanting them back in after a course of chemotherapy to kill off their own immune system - effectively "rebooting" their immune system. This is a major procedure, and not for everyone with MS. All of the 35 participants were severely disabled by MS and had aggressive disease, and two of them died as a result of the procedure: however, 25% of them were no worse 15 years later, as would have been expected.
Two recent studies, in the USA and Argentina, have reported on the results of treating people with MS with parasitic worms called helminths. The theory is that this relatively harmless treatment will alter immune activity. Because auto-immune conditions are less common in areas with low standards of hygiene and high levels of infectious disease, one theory - the hygiene hypothesis - suggests that the lack of exposure to infectious agents at early ages in the developed world can lead to allergies and other auto-immune conditions.
The American researchers gave their participants helminth eggs to drink. Other than short-term gastrointenstinal problems, there were no ill-effects. Beneficial trends were seen in MRI and immune system activity. The Argentinian study was a follow-up three years after participants originally drank the eggs. They found that infected individuals had fewer relapses, minimal changes in disability scores, and lower MRI activity. Some participants were reporting increased gastrointestinal symptoms: they were given anti-parasitic treatment, after which their scores increased to those of the participants who had not been treated.
A recent British trial confirms that cannabinoid-based Sativex can improve the symptoms of spasticity. Almost half of patients achieved an improvement of 20% or more, when taking Sativex with their existing antispasmodic medication.
Many people who are not yet able to get Sativex continue to smoke marijuana, to get the same effect. Canadian researchers have confirmed what we already knew: that cannabis users perform more poorly than non-users in terms of attention, speed of thinking, executive function, and visual perception of spatial relationship between objects. They were also more likely to be classified as globally cognitively impaired, which is a concern, given that 40-60% of people with MS are cognitively impaired to begin with.