The treatment of MS

Medication to slow the MS process

Currently MS cannot be cured, but new drugs are providing patients with measurable benefits. In treating MS, a major goal is to halt the immune response and stop demyelination. While no drug developed so far has completely achieved this goal, two new drugs show particular promise in slowing these processes. These are Interferon beta (Avonex or Betaseron) and Copolymer 1 (Copaxone).

Interferon beta works against MS by down-regulating the immune response. Interferon beta has been shown to decrease the relapse rate in RR MS, decrease the number of active and new CNS lesions, delay the progression and reduce the disability of the disease.

Copolymer 1 works against MS by interfering with the T cells that attack myelin, thereby suppressing the immune response against myelin. Copolymer 1 has also been shown to decrease the relapse rate in RR MS and reduce the disability. Patients may experience side effects from these drugs, however the side effects are usually manageable and may decrease over time. Both drugs are available for use in the treatment of MS and are currently used separately, not together.

Medication to treat symptoms

A number of medications are also available that can provide patients with some relief from the symptoms of MS, even though they may not necessarily address the causes of MS or slow the progression of the disease. These medications include drugs for treatment of fatigue, pain, spasticity, tremors, bladder urgency, constipation and other symptoms, and antidepressants. Because of the variable course and severity of MS, not all medications will be appropriate for every patient. When deciding which medications might be helpful, patients should consult with their physicians to develop a treatment plan based on their individual needs.

Future treatment--vaccines

Despite the improvements that have been made in managing MS, research continues on a number of other potential approaches for treating MS. Two approaches, vaccination and oral administration of antigens to induce immune tolerance, show early promise. The potential of these approaches lies in the hope that the immune response to the central nervous system can be interrupted by selectively destroying or suppressing the self reactive T cells.

In developing a vaccine against MS, the basic idea is that self reactive T cells, or some component of them, might be able to stimulate an immune response against these harmful T cells, destroying them before they can damage the central nervous system. In theory, if the self reactive T cells can be stopped before they can damage the central nervous system, the progression of MS might be halted. Experiments conducted in animal models for MS have shown that animals can be vaccinated to induce an immune response against the T cells that lead the attack on the central nervous system. Clinical trials in humans have shown some success in generating an immune response to self reactive T cells, but further research will be required to determine if these methods will be useful in altering the course of MS and if the vaccines can do so without resulting in damaging side effects.

To induce immune system tolerance to the central nervous system in patients with MS, researchers are studying the effectiveness of orally delivered myelin or myelin associated proteins in suppressing the immune system's reaction to the central nervous system. Experiments in animal models for MS have shown that the oral administration of central nervous system antigens such as myelin can induce immune system tolerance, thereby stopping the reaction against the central nervous system. Early clinical trials in MS patients have shown promising results, but further studies will be necessary to demonstrate the utility, effectiveness and safety of this approach.