Early intervention could slow the onset of multiple sclerosis symptoms, study finds

Start treatment for multiple sclerosis early — even before symptoms start — could possibly delay the onset of the disease, new research suggests.

The preliminary results of a small Phase 3 clinical trial showed that a drug called teriflunomide can delay or prevent symptoms of MS in people with what is called radiologically isolated syndrome, which causes the same brain and spinal cord damage seen in people with MS. The results will be presented next week at the 75th Annual Meeting of the American Academy of Neurology In Boston.

About half of people with IRS go on to develop MS.

“The goal of treatment in the RIS phase is to keep a patient in the 50% who do not convert to MS in 10 years, to stop it before the disease becomes symptomaticsaid Dr. Orhun Kantarci, a neurologist at the Mayo Clinic in Rochester, Minnesota, and co-author of the new study.

There is currently no Food and Drug Administration-approved treatment for RIS, but early intervention is crucial, experts say.

“Once the damage starts to accumulate and the disability starts to develop, we can’t reverse that,” said Dr. Jeffrey Cohen, a neurologist at the Cleveland Clinic who was not involved in the research. . “So it’s very important to prevent that from happening in the first place.”

MS is a disease of the central nervous system that affects the brain and spinal cord. The disease can cause a number of symptoms of varying severity, including vision problems, muscle weakness, numbness and difficulty concentrating, according to National Institutes of Health.

People with RIS can have very subtle symptoms that go unnoticed, said Dr. William Shaffer, a neurologist at UCHealth in Fort Collins, Colorado, who was also not involved in the trial. Early treatment could prevent progression as soon as lesions are detected, he said.

The drug teriflunomide, sold as Aubagio, is already approved to treat patients with the most common type of MS, called relapsing-remitting MS. It counts for 85% of all cases. Sanofi, which makes the drug, helped fund the trial.

The new trial is the second to test whether an approved MS drug is able to prevent symptoms in people with RIS. THE ARISE trial tested another MS drug, called Tecfidera, in 87 people in the United States and found it effective in delaying or preventing MS symptoms.

The latest study included 89 adults from Europe and Turkey with an average age of 40 who were followed for two years. Seventy percent were female and all had RIS lesions that were revealed on MRI, but none had symptoms of MS.

Compared to those who received a placebo, those who were treated with teriflunomide had a 63% reduced risk of developing early symptoms of MS, including numbness and tingling and balance problems or dizziness.

“The drugs seem to work better when started earlier,” Cohen said.

Although the trial only lasted two years, Kantarci said that matches the study length of the drugs in MS clinical trials, and the results still suggest long-term results.

Who should benefit from early treatment for MS?

While early intervention is expected in other diseases that may show up on scans before they cause symptoms, such as breast and colorectal cancers, that’s not the case for MS, Kantarci said. .

But unlike breast and colorectal cancer, people are not screened for RIS; it is typically found by chance when people have a brain or spinal MRI for other reasons. Kantarci doesn’t think that should change; RIS is rare and does not warrant routine screening, he said.

Moreover, since only half of patients with IRS develop MS, early treatment would be unjustified for the other half.

“Therapies have side effects and some risks, like all drugs, and they’re expensive,” said Dr. Nancy Sicotte, director of the Center for Multiple Sclerosis and Neuroimmunology at Cedars-Sinai in Los Angeles.

A better understanding of RIS could help guide physicians to which patients would benefit the most from early intervention.

Previous research has already identified some specific lesions in RIS patients that seem to indicate that a person will develop MS. In the future, Sicotte said, early intervention may be reserved for these patients.

Kantarci accepted.

From previous studies, “we know that some patients are more likely to become symptomatic of MS, including those who are younger or who have cerebrospinal fluid and spinal cord problems suggestive of MS,” said he declared. “We would like them to be the ones getting the treatment.”

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