Only 50 years ago, there was no way possible to treat multiple sclerosis. Then, in the mid-1970s, a team of researchers and doctors used chemotherapy for the first time to treat the neurological disease. Since that first treatment, more than 10 new drugs have been developed and approved. Some of these treatments include infusions while others include oral medications or shots.
With all of the new treatments and ongoing research, there is still no cure. The best that most doctors can hope for is to control or minimize the symptoms of multiple sclerosis.
A new treatment for MS?
However, a new drug on the market, Ocrevus (ocrelizumab), looks to be an effective approach at controlling the disease. Ocrevus takes a new approach to minimizing the inflammation that drives multiple sclerosis and is showing some promising results. Unfortunately, the cost of the drug is around $65,000 a year.
Should I take Ocrevus to treat my multiple sclerosis?
As an MS patient and scientific journalist, Brandie Jefferson asked that very question. Like the 2 million plus other patients worldwide, Jefferson found out quickly that deciding whether or not to try a multiple sclerosis treatment is never a quick and easy task.
The U.S. Food and Drug Administration (FDA) approved Ocrevus in March of 2017 for aggressive treatment of the most common type of multiple sclerosis, relapsing-remitting multiple sclerosis (RRMS). People with RRMS find that when their symptoms are at their worst, they will have flare-ups, then soon after they will have brief periods of remission and, occasionally, a partial or full recovery from symptoms.
F. Hoffmann-La Roche, the manufacturer of Ocrevus, conducted two clinical trials for the drug. The clinical trials revealed that the patients who had RRMS and were given Ocrevus had about 95% fewer lesions on the spinal cord and brain, and about 50% fewer relapses than the RRMS patients who had been given a common therapy drug, Rebif.
As an autoimmune disease, MS results in the body attacking itself. The worst effect of the attacks of the immune system tend to fall on the nerve endings in the body, as well as the myelin (the tissue of fat that coats the nerve endings). As a result of the body's immune system attacks on the nerve endings in the body, the central nervous system cannot communicate with the nerves effectively. This lack of communication and collaboration between the central nervous system and the nerve endings results in several different symptoms, including extreme fatigue, debilitation pain, general disability, confusion, and trouble with speaking clearly.
Over the past 30 years or so, the majority of multiple sclerosis research and treatment has been centered around altering the manner in which the white blood cells, T cells, select the proper foreign agents to target and attack. Dr. Stephen Hauser says this is the reason why it took researchers so long to develop B cell therapy approaches.
B cells are another type of white blood cell that is less concentrated in the body than T cells. B cells work similarly to T cells in helping the body to fight against foreign materials, such as infection. The new drug, Ocrevus, works effectively by targeting B cells. According to Dr. Hauser, recent research has revealed that all other previous therapy drugs also worked against B cells, rather than being selective for T cells. Houser also says that the effectiveness of those previous drugs was by accidental occurrence, rather than by design, as in with Ocrevus.
Not only has the FDA approved Ocrevus for treating relapsing-remitting multiple sclerosis, but the FDA has also approved Ocrevus for the treatment of primary-progressive multiple sclerosis and is the first treatment that the FDA has approved for this much more aggressive form of MS.
Whereas relapsing-remitting multiple sclerosis allows the patients with at least moments of remission, primary-progressive multiple sclerosis leads the patient into worsening symptoms with little to no remission at all.
A second clinical study by F. Hoffman-La Roche revealed that placebos were outperformed by Ocrevus in their patients who had PPMS. While the author admits that the results in this second trial were not as good as they were with RRMS, the drug was still slightly effective at slowing down the progression of myelin lesions as well as physical disability.
Jefferson says she has had RRMS for over 15 years and has been taking Rebif and another drug that was released in the 1990s, Avonex. Jefferson recently also added Tysabri, which is an infusion that she gets once every month and that works by preventing specific immune-related cells from getting across her blood and brain barrier.
After meeting with Dr. Houser and learning all about this stunning new effective drug, Ocrevus, Jefferson wanted to know whether or not she should try it. She contacted her physician, Dr. Newsome at the Johns Hopkins Hospital of Baltimore and he told her that she should not switch because she was doing so well on her current therapy.
Dr. Newsome told Jefferson that her last MRI had looked good, clear of demyelination and that she had been effectively managing her pain for several years already.
Dr. Newsome's biggest concern with trying Ocrevus is the novelty and safety concerns associated with a new drug. While all drugs can carry potential risks, at least with Tysabri, the risks had already been understood and doctors knew how to manage those risks.
Dr. Newsome also expressed some concern for the potential of an increased risk for cancer, especially breast cancer, in some of the trial patients who tried Ocrevus. While the rate of cancer that patients developed was not necessarily more than the general population experiences, there was a record of some trial participants developing cancer later on.
The bottom line
So, while Brandie Jefferson won't be switching to Ocrevus, there is still a lot of benefits offered to those patients whose doctors do recommend it. Dr. Houser believes strongly in the potential for Ocrevus or other drugs that target B cells to one day be able to completely destroy every single one of the damaging cells that contribute to the painful and disabling symptoms of MS.
With B cell-targeting drug therapies, we may be just one clinical trial away from developing a complete cure for MS.
Jefferson, B. (2017, July 14). There's an Amazing New Drug for Multiple Sclerosis. Should I Try It? [Web]. In NPR. Retrieved from: http://www.npr.org/sections/health-shots/2017/07/14/529835628/theres-an-amazing-new-drug-for-multiple-sclerosis-should-i-try-it