For a century, the only therapies to help MS were those that addressed its symptoms. It would be fair to describe that time as the “Descriptive Era,” when scientists learned to separate the disease from other neurological conditions. During this time, much was learned about the clinical, pathological, immunological and epidemiological aspects of MS, as well as the condition’s genetics, course and prognosis. But no matter which treatment was used, the outcome of the disease remained unaffected.
Then, in 1993, Betaseron was approved for the treatment of MS. A randomized clinical trial had shown that interferon beta-1b had both a clinical effect on relapses and a more striking effect on lesions caused by MS and seen on MRI. The discovery ushered in a decade of clinical trials which led to the approval of two more interferon therapies, Avonex and Rebif, as well as Copaxone (glatiramer acetate).
More recently, drugs such as Novantrone, an antineoplastic formerly only used to treat cancer, and Tysabri, a laboratory-produced monoclonal antibody have been approved for the treatment of MS. Waiting in the wings are even more agents and combination therapies. The list of clinical trials currently underway for MS treatments numbers about 140.
Medical advances do not usually happen suddenly. More commonly, incremental steps lead to increasingly better answers to the many questions that surround a medical condition. When a substantial advance happens, it generally brings together research that previously had taken many different directions.
That was the case for Betaseron. Leading up to its approval, prior studies had clarified much about how MS operates in the body, permitting scientists to both better target the condition and assess the effects of new therapies.
Classifying MS into types, such as relapsing-remitting and secondary progressive, allowed researchers to better select patients for trials and to note which groups responded best to a therapy. The development of clinical assessments of disability, pioneered by John Kurtzke, provided a means of measuring change in the patients’ conditions.
Meanwhile, advances in MRI techniques provided a noninvasive and objective measurement of change in the inflammatory process in the brain. Researchers also learned from previous clinical trials, helping them to design better studies that resulted in convincing and statistically significant evidence that a drug was able to help slow MS progression.
Fifteen years have passed since Betaseron was first approved to treat MS in the United States. In that time, the amount of funding, number of researchers and array of potential therapies for MS has increased dramatically. The promise for the future of MS treatment has greatly improved and the rate of discoveries is only escalating.
The next decade will outpace the last in benefiting people with MS. That is not just a hope – progress is happening now. Each meeting of researchers who study MS provides a remarkable series of building blocks that will lead to the next discoveries.
T. Jock Murray, M.D., is Emeritus Professor at Dalhousie University in Halifax, Nova Scotia. Twenty-five years ago, he founded the Dalhousie MS Research Unit. He has authored more than 200 medical articles and books, including “Multiple Sclerosis: A Guide for the Newly Diagnosed,” “Multiple Sclerosis: The History of a Disease” and “Multiple Sclerosis: The Guide to Treatment and Management.”
(Last reviewed 7/2009)