A Better Treatment Approach for Relapsing Remitting Multiple Sclerosis?

Relapsing remitting multiple sclerosis (RRMS) is an aggressive, rapidly debilitating form of multiple sclerosis. Individuals with this type of MS experience deterioration at a quicker rate than other forms, and don’t have as many treatment options. In terms of treatment for all types of MS, the general approach has been to start with medications with less side effects, lesser dosage, and to focus on preventing the reoccurrence of an MS event.

A research study has been done that states that perhaps, this approach isn’t the most effective way to go about treatment RRMS patients. The research promotes an aggressive form of treatment early on to prevent rapid deterioration and maybe even reversal of symptoms. This research also talks of an early window prior to damage incurred by the illness, that may be the best time for effective treatment.

The Study

The data from this study was taken from several different institutions specializing in the treatment for RRMS. The study took a consistent approach in researching each case, diagnosis, and treatment of patients with RRMS. Not all patients with RRMS were studied, the patients used in the research had to meet a set of requirements. The patient had to be categorized as high risk upon diagnosis, which tends to be an incredibly broad and descriptive definition. To simplify it, the researchers set a requirement standard that outlined what the patients were required to have undergone treatment wise and progression wise over a set period of time. The study also required that patients were diagnosed within a certain time frame before treatment.

The complexity of the study and the research involved gave the researchers an idea of what treatment was effective in the early onset of RRMS. As sufferers of RRMS already know, the progressive form is quickly debilitating, but this research study aims at preventing the progression by use of disease modifying agents at a specific point in the disease. This “specific point” is before irreversible damage has occurred, before lesions have formed in certain areas, and within five years of initial diagnosis. When treatment aggressively at this point, research showed that patients progressed less rapidly and, overall, had a better outcome and quality of life.

This study also focused on patients who had been prescribed specific forms of DMT’s that would categorize the treatment as aggressive. The patients had to have undergone aggressive treatment early on to prevent progression and irreversible damage.

The Results

The results of the study showed that patients who fell within the high risk category outlined by researchers, who had received the described disease modifying agent treatments early on in diagnosis were showed to have a slower progression of disease. The results stated that patients can undergo aggressive treatment early on instead of later on to lessen their progression. The study also used patients who were diagnosed with an alternative form of MS, but were showing signs of RRMS – and this treatment proved to eliminate the progression from one form of MS to RRMS. These results are exciting for anyone recently diagnosed with MS, or someone who is categorized as high-risk.

An excerpt from the conclusion of the study states that,” Increasing evidence suggests that early, optimal intervention is needed to prevent inflammatory events that ultimately lead to a progressive disease course. Because patients with high-risk MS accumulate irreversible neurologic damage more rapidly than other patients, they have a limited opportunity in which to change the disease trajectory. In the author's opinion, these patients are the best candidates for early treatment with strong, high-efficacy DMTs, either as initial treatment or in response to the earliest sign of suboptimal DMT response. With the growing understanding that our ability to modify disease in an individual patient diminishes with time, clinicians are faced with balancing the risk of inaction with that of acting on the basis of encouraging, yet incomplete, information (Fernandez, 2017).”

Disease Modifying Agents

Disease modifying agents are just that; modifiers of disease. These agents modify the effect the disease has on the body (ideally). Everyone responds differently to treatment and DMT’s are no exception. There are 6 approved on the market today and are particularly important to high risk RRMS patients because it is one of their only options for treatment.

The DMT’s that patients were treated with in this study were Fingolimod, Natalizumab, and Alemtuzumab. All three DMT’s work in different ways for the body and against the disease manifestation within the body. Only patients who were treated with these DMT’s in the early stages were used as research during this trial.

What Does This Mean for Multiple Sclerosis?

Well, it can mean a lot of things. First of all, don’t assume you are disqualified from aggressive treatment because you don’t fall within the specifications. With MS, as the disease continues, progression continues. As progression continues to move forward, MS sufferers are at risk for developing RRMS. This study is also geared towards those patients as well. Anyone who has a high probability for transitioning to RRMS, or who has been recently diagnosed, shows that they could benefit highly from aggressive DMT therapies.

For anyone currently suffering from RRMS, you know how important this breakthrough is. RRMS is one of the most dreaded forms of MS because of how rapidly progressing it is. Patients are often debilitating shortly after diagnosis and have a difficult time functioning during treatment because of the side effects of both the disease and the medications they are prescribed. It can feel as though patients are on a downhill spiral, but this research study shows that they don’t have to be. If aggressive intervention early on in the disease is all that’s needed to prevent the debilitation, why wouldn’t a physician head this? As a patient, it is important to do your research and listen to your body.

You know what you feel and what is going on inside you, all the doctor has to go off of is pictures, his history with patients, and what you tell him. Patients often look to doctors for answers and to guide them, heading every word they say. As a patient, you need to look at doctors as more of a team member. You both will work together to get your MS under control. Doctors often enjoy when patients work with them and ask questions, because it shows (to them) that the patient is involved in their treatment and understands what is going on.

Physicians are more fearful of patients who simply agree to everything they say yet continue to be unhappy with the treatment prescribed. If your physician doesn’t treat you like a team member, find someone else. RRMS is too devastating a disease to not have an amazing support system behind you. Find a doctor you are comfortable with asking questions, offering suggestions, and discussing research. Some doctors enjoy when patients talk about recent research studies and clinical trials going on near them. Doctors will welcome the enthusiasm that their patients has regarding their treatment, and if they don’t, you need to find a new doctor.

As stated before, MS is too devastating to not have an encouraging team behind you. If you don’t have one now, you need to start searching.

References

http://www.msard-journal.com/article/S2211-0348(17)30153-0/fulltext

http://dx.doi.org/10.1016/j.msard.2017.07.003