Researchers are reporting exciting work under way to develop new treatments for multiple sclerosis.
A number of clinical trials are under way at Shepherd Center and elsewhere.
The U.S. Food and Drug Administration (FDA) has approved Plegridy™ (peginterferon beta-1a), a new treatment for people with relapsing forms of multiple sclerosis (RMS).
Clinical trials show the drug reduces relapses, disability progression and brain lesions.
MS management can be divided into three areas: relapse treatment, symptom management and disease modification.
Listen in as Ben Thrower, M.D., discusses the latest developments in MS management at Shepherd Center.
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Latest Development in MS Treatment and Research
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Learn more about Dr. Thrower
Ben Thrower, M.D.
Dr. Thrower is the Medical Director of the MS Institute at Shepherd. He previously served as the Medical Director of the Holy Family Multiple Sclerosis Institute in Spokane, WA. In Spokane he was the Chair of the Inland Northwest Chapter of the NMSS. In 2000, he was awarded the Norm Cohn Hope Chest Award by the National MS Society, recognizing his work with the MS community. In 2005, he was the first physician inductee into the Georgia Chapter of the National MS Society Volunteer Hall of Fame.Learn more about Dr. Thrower
Transcription:
Latest Development in MS Treatment and Research
Melanie Cole (Host): Managing multiple sclerosis has come a long way from the days of having very little to offer to now having a toolbox full of treatment options. My guest today is Dr. Ben Thrower. He’s the medical director of the MS Institute at Shepherd Center. Welcome to the show, Dr. Thrower. Tell us a little bit about what’s going on in the world of treatment for multiple sclerosis.
Dr. Ben Thrower (Guest): Thank you very much for having me on. It is an exciting time in MS treatment. We have had just in the past month two new treatments available for multiple sclerosis, and it seems like we’ve come a long ways from 1993, as you mentioned, having no treatment options available to now having 12 FDA-approved medications out there to offer the person with multiple sclerosis.
Melanie: What are the medications intended to do? Is there no cure for MS? Can we slow down the progress of it? What are they intended to do?
Dr. Thrower: Everything that we do in multiple sclerosis could be put into one of three boxes. We are either treating acute attacks or relapses or managing symptoms, or we’re altering the long-term course of the illness. It’s really in that last box where we have seen the most significant advances in recent years.
Melanie: Okay, so the medications that are intended to prevent relapse, what do they do? And speak a little bit about some of these treatments, Dr. Thrower, and the side effects, because I think depression and worrying about the side effects of medications—and some of them are pretty strong medications—may be an issue for the support staff for someone living with MS.
Dr. Thrower: Absolutely. In that third box, altering the course of multiple sclerosis, we really would like to do three things. We would like to prevent or make less likely a relapse. We would like to slow progression of disability, and we would like to prevent new lesions on MRI. It’s important to note that these medications don’t reverse the symptoms. That’s a common issue that we see. Someone spends a lot of time thinking about which of these drugs they want to be on and they start the medication, and they come back and then say, “You know, doc? I don’t think this is working for me.” When we drill down on that, say, “What do you mean it’s not working?” what they frequently mean is that it’s not reversing the symptoms. And it’s such an odd class of medicines in that usually when you take a drug, you expect something to get better, whether it’s pain, your blood sugar, your blood pressure. These drugs are not that kind of medication. These drugs are designed like an insurance policy for the future so they’re going to, again, help prevent problems down the line. Balancing the effectiveness versus the safety is crucial. Multiple sclerosis is an autoimmune disease. It is an overactive immune system, and in the past, there was a tendency to use medications that squashed the immune system into submission. And now we have medicines that are more specific and are really focused at really putting the immune system back in balance, but they still have potential side effects. We always have to have that open two-way dialogue between the healthcare provider and the person with MS and their family about what are your goals, what’s your risk tolerance, what are the options we have on the table, and come up with a reasonable plan going forward, and then continuously monitor for both the effectiveness of the drug, how well that drug fits with the person’s lifestyle, are they actually taking the medication or are they just trying to make us happy by saying that they’re taking it when maybe they’re skipping some doses, then looking at safety, primarily through laboratory testing.
Melanie: Dr. Thrower, you have a bit of a wish list for things for people to do when they’re dealing with multiple sclerosis. Go over that with us, if you would.
Dr. Thrower: My wish list for the person with MS is that first off, that we get them diagnosed quickly and accurately. We know that a lot goes on under the surface with multiple sclerosis and that damage is occurring sometimes even in the setting of the person feeling well. We want to get them on treatment quickly, but we also want to get the diagnosis correct so that we haven’t put a label on someone that’s not appropriate and send them down a path of a lifetime of treatment that may not be appropriate. Secondly, we would like to look at the symptom management piece in terms of improving quality of life right now, because while the drugs we mentioned that alter the course of MS may not make you feel better right now, we have a whole separate toolbox of things that can. We want to make sure that we’re addressing those things. We want to emphasize to the person that MS is part of their overall wellness, that they are not now just a person with multiple sclerosis. Theyhave the potential for other health issues, and we do not want to get nearsighted and only focus on the MS to the exclusion of their diet and other health factors that might be important for them down the line. I think that we would need to emphasize to the person in our wish list that it is a two-way street and that that dialogue back and forth between the healthcare provider and the person with MS is crucial to their long-term success. We mentioned the three boxes of treatment that we have right now. There’s a fourth that we don’t have, that we desperately want, and I think we will have. That’s neural repair—fixing the damage, reversing symptoms so that that person who does have some level of disability might be able to get rid of that disability in the future. It was once felt to be a pipedream and something like science fiction, but now it is thought to be a realistic possibility, and we’re seeing advances on that front.
Melanie: Speak about the advances on the front of research and what’s going on on the horizon, neural repair being certainly one of the most optimal ones. What else is going on there on the horizon for MS research and treatment?
Dr. Thrower: As I mentioned earlier, we’ve seen two medications approved just here within the past couple of months. We have a drug called Plegridy, which is an improvement, if you will, an extended release form of an interferon that was available previously. The previous form was a once-a-week dose. Wow we have an every-two-week dose. Just last week, the FDA approved a drug called Lemtrada, which is probably among the more potent drugs that we have in our toolbox. It’s a once-a-year IV therapy. It is certainly not a first-line treatment. It’s something that we would reserve for people who have maybe tried other treatments and not had as good of a result with those treatments as they would like. Again, nice to have more things available for managing MS. We have, as we go forward, as I mentioned, the realistic hope of neural repair. There’s a lot of emphasis on stem cell research. Typically, when people think of stem cells, they think of embryonic stem cells, but some of the most exciting developments that we’re seeing in the multiple sclerosis world are more along the lines of adult stem cells, the advantages being that this comes from the individual themselves, there may be less potential for rejection, for tissue developing that you really don’t want to see develop. That’s quite exciting. There is a treatment in development that is in phase two testing right now in Europe called anti-LINGO, which would let oligodendrocytes or cells in the central nervous system make myelin that are sitting there right now and not really being used. It would let those cells come out of that, if you will, saving the count and be used to repair some of the damage. We do now have the safety results from the phase one trial. The treatment appeared to be safe. We’re waiting for results in the phase two testing. If that looks positive, hopefully then goes into multi-site, multinational phase three trial. Again, very exciting to see this sort of things moving forward.
Melanie: That really is fascinating, Dr. Thrower. In just the last few minutes, if you would, give your best advice to those living with MS and why they should come to the Shepherd Center for their multiple sclerosis treatment and care.
Dr. Thrower: Multiple sclerosis is complex, and one of the things that I realized early on in my career as a neurologist is that I really couldn’t do it all in terms of offering comprehensive care to the person with MS. It does take a team approach. There are a lot of different specialties that offer something important in the management of multiple sclerosis, from physical therapists, occupational therapists, speech therapists, case managers to help you wade through the confusing world of insurance and paperwork and prior authorizations. We have exercise physiologists, psychologists, neuropsychologists, pain management specialists, physiatrists. I would argue that Shepherd Center has one of the most comprehensive teams of MS providers in the United States, and I think that it’s something that I’m very proud of, not specifically for things that I do but for things that the team does. I would encourage people to look at that comprehensive approach to multiple sclerosis. If you have a complex health problem like multiple sclerosis, you need a comprehensive team to help you manage that MS going forward.
Melanie: Thank you so much, Dr. Ben Thrower. You’re listening to Shepherd Center Radio. For more information, you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
Latest Development in MS Treatment and Research
Melanie Cole (Host): Managing multiple sclerosis has come a long way from the days of having very little to offer to now having a toolbox full of treatment options. My guest today is Dr. Ben Thrower. He’s the medical director of the MS Institute at Shepherd Center. Welcome to the show, Dr. Thrower. Tell us a little bit about what’s going on in the world of treatment for multiple sclerosis.
Dr. Ben Thrower (Guest): Thank you very much for having me on. It is an exciting time in MS treatment. We have had just in the past month two new treatments available for multiple sclerosis, and it seems like we’ve come a long ways from 1993, as you mentioned, having no treatment options available to now having 12 FDA-approved medications out there to offer the person with multiple sclerosis.
Melanie: What are the medications intended to do? Is there no cure for MS? Can we slow down the progress of it? What are they intended to do?
Dr. Thrower: Everything that we do in multiple sclerosis could be put into one of three boxes. We are either treating acute attacks or relapses or managing symptoms, or we’re altering the long-term course of the illness. It’s really in that last box where we have seen the most significant advances in recent years.
Melanie: Okay, so the medications that are intended to prevent relapse, what do they do? And speak a little bit about some of these treatments, Dr. Thrower, and the side effects, because I think depression and worrying about the side effects of medications—and some of them are pretty strong medications—may be an issue for the support staff for someone living with MS.
Dr. Thrower: Absolutely. In that third box, altering the course of multiple sclerosis, we really would like to do three things. We would like to prevent or make less likely a relapse. We would like to slow progression of disability, and we would like to prevent new lesions on MRI. It’s important to note that these medications don’t reverse the symptoms. That’s a common issue that we see. Someone spends a lot of time thinking about which of these drugs they want to be on and they start the medication, and they come back and then say, “You know, doc? I don’t think this is working for me.” When we drill down on that, say, “What do you mean it’s not working?” what they frequently mean is that it’s not reversing the symptoms. And it’s such an odd class of medicines in that usually when you take a drug, you expect something to get better, whether it’s pain, your blood sugar, your blood pressure. These drugs are not that kind of medication. These drugs are designed like an insurance policy for the future so they’re going to, again, help prevent problems down the line. Balancing the effectiveness versus the safety is crucial. Multiple sclerosis is an autoimmune disease. It is an overactive immune system, and in the past, there was a tendency to use medications that squashed the immune system into submission. And now we have medicines that are more specific and are really focused at really putting the immune system back in balance, but they still have potential side effects. We always have to have that open two-way dialogue between the healthcare provider and the person with MS and their family about what are your goals, what’s your risk tolerance, what are the options we have on the table, and come up with a reasonable plan going forward, and then continuously monitor for both the effectiveness of the drug, how well that drug fits with the person’s lifestyle, are they actually taking the medication or are they just trying to make us happy by saying that they’re taking it when maybe they’re skipping some doses, then looking at safety, primarily through laboratory testing.
Melanie: Dr. Thrower, you have a bit of a wish list for things for people to do when they’re dealing with multiple sclerosis. Go over that with us, if you would.
Dr. Thrower: My wish list for the person with MS is that first off, that we get them diagnosed quickly and accurately. We know that a lot goes on under the surface with multiple sclerosis and that damage is occurring sometimes even in the setting of the person feeling well. We want to get them on treatment quickly, but we also want to get the diagnosis correct so that we haven’t put a label on someone that’s not appropriate and send them down a path of a lifetime of treatment that may not be appropriate. Secondly, we would like to look at the symptom management piece in terms of improving quality of life right now, because while the drugs we mentioned that alter the course of MS may not make you feel better right now, we have a whole separate toolbox of things that can. We want to make sure that we’re addressing those things. We want to emphasize to the person that MS is part of their overall wellness, that they are not now just a person with multiple sclerosis. Theyhave the potential for other health issues, and we do not want to get nearsighted and only focus on the MS to the exclusion of their diet and other health factors that might be important for them down the line. I think that we would need to emphasize to the person in our wish list that it is a two-way street and that that dialogue back and forth between the healthcare provider and the person with MS is crucial to their long-term success. We mentioned the three boxes of treatment that we have right now. There’s a fourth that we don’t have, that we desperately want, and I think we will have. That’s neural repair—fixing the damage, reversing symptoms so that that person who does have some level of disability might be able to get rid of that disability in the future. It was once felt to be a pipedream and something like science fiction, but now it is thought to be a realistic possibility, and we’re seeing advances on that front.
Melanie: Speak about the advances on the front of research and what’s going on on the horizon, neural repair being certainly one of the most optimal ones. What else is going on there on the horizon for MS research and treatment?
Dr. Thrower: As I mentioned earlier, we’ve seen two medications approved just here within the past couple of months. We have a drug called Plegridy, which is an improvement, if you will, an extended release form of an interferon that was available previously. The previous form was a once-a-week dose. Wow we have an every-two-week dose. Just last week, the FDA approved a drug called Lemtrada, which is probably among the more potent drugs that we have in our toolbox. It’s a once-a-year IV therapy. It is certainly not a first-line treatment. It’s something that we would reserve for people who have maybe tried other treatments and not had as good of a result with those treatments as they would like. Again, nice to have more things available for managing MS. We have, as we go forward, as I mentioned, the realistic hope of neural repair. There’s a lot of emphasis on stem cell research. Typically, when people think of stem cells, they think of embryonic stem cells, but some of the most exciting developments that we’re seeing in the multiple sclerosis world are more along the lines of adult stem cells, the advantages being that this comes from the individual themselves, there may be less potential for rejection, for tissue developing that you really don’t want to see develop. That’s quite exciting. There is a treatment in development that is in phase two testing right now in Europe called anti-LINGO, which would let oligodendrocytes or cells in the central nervous system make myelin that are sitting there right now and not really being used. It would let those cells come out of that, if you will, saving the count and be used to repair some of the damage. We do now have the safety results from the phase one trial. The treatment appeared to be safe. We’re waiting for results in the phase two testing. If that looks positive, hopefully then goes into multi-site, multinational phase three trial. Again, very exciting to see this sort of things moving forward.
Melanie: That really is fascinating, Dr. Thrower. In just the last few minutes, if you would, give your best advice to those living with MS and why they should come to the Shepherd Center for their multiple sclerosis treatment and care.
Dr. Thrower: Multiple sclerosis is complex, and one of the things that I realized early on in my career as a neurologist is that I really couldn’t do it all in terms of offering comprehensive care to the person with MS. It does take a team approach. There are a lot of different specialties that offer something important in the management of multiple sclerosis, from physical therapists, occupational therapists, speech therapists, case managers to help you wade through the confusing world of insurance and paperwork and prior authorizations. We have exercise physiologists, psychologists, neuropsychologists, pain management specialists, physiatrists. I would argue that Shepherd Center has one of the most comprehensive teams of MS providers in the United States, and I think that it’s something that I’m very proud of, not specifically for things that I do but for things that the team does. I would encourage people to look at that comprehensive approach to multiple sclerosis. If you have a complex health problem like multiple sclerosis, you need a comprehensive team to help you manage that MS going forward.
Melanie: Thank you so much, Dr. Ben Thrower. You’re listening to Shepherd Center Radio. For more information, you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening, and have a great day.