Are we close to a cure for Multiple Sclerosis?

Posted on 12 February 2019 in MS Cure

Some people say, if you don’t know what is causing MS, how can you talk about a cure?

I think yes, we can!

In some cancers, like large-cell lymphoma & testicular cancer, Oncologists do speak about cure in spite of not knowing what the causes of these cancers are.

Part of the difficulty in answering this question comes from the absence of an agreed definition of cure in MS. It is difficult too to find an accepted definition of the word cure for many medical conditions.

Appendicitis is cured surgically while pneumonia is cured with antibiotics. On the other hand, diabetes and hypertension are managed, treated, or controlled. You would not talk about cure of your hypertension or diabetes; but you are interested in their control. In cancer care, common terms used for patients who are free of disease include, “in remission,” and “no evidence of disease”. If cancer patient remains in complete remission for 5 years or more, some Oncologists may consider that this person is cured.

MS is increasingly recognized to be a potentially treatable condition especially if diagnosed early and if treatment starts soon after diagnosis with the most effective immune-therapy. In this situation, you have the best chance of a “cure”.

The hard or “ideal MS cure” would probably look like this:

  • No inflammatory activities (clinical, MRI, bio-markers)
  • No MS symptoms
  • No progression including brain atrophy
  • Repair and reversal of existing disability and damages
  • No late disease recurrence
  • No further treatment needed

In other word: wipe the disease and its effects and restore functions.

No MS symptoms alone might be considered a cure by some. A person with MS tells me “people with MS get frustrated with scientists’ definitions of a cure… when I take a paracetamol and it cures my headache, scientists may not technically see it as a cure, but as a layperson, I am happy with the result and see it as a cure”

The repair and progression halt might be troublesome issues as some believe that progression is independent from neuro-inflammation, this opinion thankfully is not a consensus at present. We don’t have effective repair medications at present either.

Our currently available treatments are unlikely to satisfy all of the above requirements for a cure but can control/manage the disease in many PwMS, keep the disease in remission and improve their quality of life for years to come. This is obviously not for every PwMS and especially not for people with advanced MS.

Whether cure or remission, it is always a retrospective phenomenon which you will know only after prolonged period of follow-up.

After how long?  Probably between 5-15 years.

If cure means ‘no more disease activity and no further treatment’, this is likely to be achievable with the currently available high efficacy medications.

The highly efficacious immune reconstitution therapies (IRTs) {alemtuzumab, cladribine & stem cell (AHSCT)} produce results that keep many PwMS under remission and might be as near to the ideal cure as we can at present; they are given as short courses that permanently remould the immune system back to “normal”. They carry significant side effects profile; some are life-threatening.

If you are after remission with less risky treatment; you might choose one of the highly efficacious DMTs that can keep the disease in remission for a long period, but you need to continue using these medications regularly and need monitoring. When you stop these medications, your MS disease activity tends to return.

So which DMT is good for me? This will be a future article in this series.

MS has been known for about 150 years. In the last 50 years we witnessed extensive research in its various aspects including: genetic, epidemiological, neurobiological, imaging, therapeutic and molecular aspects probably like no other neurological condition.

The recent speed of MS drugs discovery is more than impressive: from no therapies for about 100 years, to modestly efficacious drugs from 1993 to many highly effective treatments from 2006.

The developments in MS treatments have produced improvements in management not seen with any other major neurological condition that I know.

Most MSologists routinely check PwMS who have relapsing MS for NEDA (No Evidence of Disease Activity, i.e no relapses, no change in disability status (EDSS) and stable MRI), this is equivalent to disease in remission

For people with progressive MS (SPMS & PPMS), the goal is NEPAD (no evidence of progression or active disease) again is a form of disease in remission.

To achieve NEDA or NEPAD, your best option is to have a holistic multi professional approach to your management not only to deal with the best immune-therapy but also management of your MS symptoms, neuro-rehab issues, cognitive & psychology, co-morbidities and life style issues.

In the last 5 years, I meet increasing numbers of PwMS in my clinic who have no relapses, no significant MS symptoms or disability and no side effects from medications who are happy with their disease control with minimal impact on their life style; many continue to work or care for their loved ones. They have a good quality of life. This is very different from my experience years earlier. Of course, I do also see the unfortunate PwMS who have more challenging conditions.

Today, more therapies for MS are in development than ever before. Research in MS is intense, very active and highly diverse; the ideal conditions for accidental discoveries.

A cure is a real possibility in such circumstances!

I believe we are closer for a cure for MS than ever, it is likely that cure will come gradually within the next 1-2 decades in the form of increasingly effective MS medications, probably as a combination therapy similar to what happened in other difficult to treat medical conditions.

I would not be surprised if cure will come sooner as a breakthrough through one of the current research pipelines even before we know what exactly is causing MS.

It is my personal view that “remission” expressed as NEDA or NEPAD is more useful in clinical practice than targeting “cure”. If you have no relapses, no change in your neurological examination and have stable MRI scan for 5 or more years, your disease is likely to be in remission.

Dr Adnan Al-Araji,Consultant MS Neurologist

Useful sources of further information

  1. MS Trust: What would a cure for MS look like? 
  2. Multiple Sclerosis Research Blog
  3. Controversies in Multiple Sclerosis (PDF)

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