Many MS patients don’t need a ‘miracle,’ because current drugs are highly effective
It’s an apparently inescapable fact of medical science news — if it’s worth covering, it must be a cure or a breakthrough.
What the headlines can’t seem to convey is that sometimes a scientific paper is reporting a development in a long-running research program.
That was the case this week, when The Lancet published a Canadian study on treating multiple sclerosis using bone marrow transplants.
The C-word (cure) and the M-word (miracle) have appeared, even in otherwise measured reporting about a study whose results have been well known in the neurology and MS community for more than a decade.
It didn’t help that both the hospital and the funding agency used the word “breakthrough” in their media releases, and that the research group offered up their star patient, a woman with a heartwarming story about getting her life back after the treatment.
We did not see the face of the patient who died.
But the real problem here is that the media have failed to check in on the MS community since the last so-called “cure,” the discredited Zamboni “liberation therapy” that failed to hold up under rigorous scientific review.
In the shadow of the hysteria around the theory that narrowed veins caused MS, a genuine transformation in the disease has taken place.
We still think about MS as a hopeless disease where patients are doomed to slide into disability and premature death. Not anymore.
Today’s MS patients aim for something called “no evidence of disease activity,” a state that is achieved by using drugs that stop the immune system from attacking brain cells.
“We put them on a medication with very low risk and with very low complications and procedures,” says Dr. Jock Murray, a Halifax neurologist who has been treating MS patients for decades.
“Some of these things are just pills. Some are injections. There’s one, you take the treatment for five days, and a year later you take it for two days, and then you never take it again.”
“Most [MS] patients in Canada are on one of these drugs,” he said.
In other words, one of the major reasons why today’s bone marrow transplant story is not relevant to 95 per cent of MS patients is that they won’t need it.
Symptoms often reversible
“I’ve treated more than 100 people with this [drug] treatment,” said Dr. Anthony Traboulsee, medical director of the MS clinic at UBC Hospital in Vancouver.
“In up to 40 to 50 per cent of patients, many of their symptoms will reverse. And that’s the cool part,” he said.
“Fifteen years ago we were telling people, ‘We might be able to take the edge off your disease.’ Now we can say we have a good chance of shutting it down,” he said.
“Now I’m telling people when newly diagnosed, that my gut feeling is we’ve got a 90 per cent chance of controlling this super well for you, and you will have a normal or near normal life.”
None of this diminishes the work of the Ottawa team reporting the results of a 15-year study into bone marrow transplants for MS. The research is much admired by the neurology community for its rigour and care. It’s just not new.
“We’ve known the results all the way along. It’s been over 14 years,” said Murray. “From the start we knew this was not going to be a therapy for everybody. But we would learn a lot.”
The concept is to give MS patients, already suffering from an untreatable form of the disease, a new immune system using a procedure similar to the one that has been used to treat leukemia and other cancers for years.
“Ablate the bone marrow and immune system,’ said Murray. “And give them back a new immune system using their own cells.”
Several groups around the world have done similar studies. The Ottawa researchers used stronger chemotherapy and were more selective in the cells they transplanted. And they waited years before reporting their results, to be certain that the disease had been halted in the 24 patients, and that the symptoms had improved in almost half of them.
In addition to offering a new option for the most desperate MS patients, the Ottawa research also acts as a proof of principle that the immune system is the key to controlling the disease.
“We know the immune system is the actor involved. We don’t know why it initiated this damage to the nervous system or what it’s specifically trying to attack. All we know is there is great evidence that the process is of immune cells getting into the brain and causing an inflammatory reaction that destroys myelin and eventually destroys axions,” said Murray.
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