Medicine & Research

Doctor's Notes

By MS Focus Senior Medical Advisor, Ben Thrower M.D.
The MS News column includes analysis from Ben Thrower, M.D., MS Focus Senior Medical Advisor. Dr Thrower draws from the top news stories of the quarter and explains what the news means to you, the person with MS.

Researchers suggest antihistamine has remyelinating potential
In a new study involving multiple sclerosis patients with chronic optic neuropathy, researchers found that clemastine fumarate, a common antihistamine used to treat symptoms of allergies and the common cold, partially reversed damage to the visual system. The findings were presented at the American Academy of Neurology’s 68th annual meeting in Vancouver, Canada.
Thrower – This study is exciting for several reasons. Neural repair, wherein damage in the central nervous system can be fixed and the patient experiences a reversal of disability, is the one of the ultimate goals of MS research. The identification of clemastine as a drug that might potentially result in myelin repair is the result of a relatively new screening process. Using tiny artificial columns wrapped in myelin, researchers at UCSF are screening more than 1,000 FDA-approved drugs for their potential to repair damage in the central nervous system. This micropillar technology has sped up the identification of potential treatments like clemastine.
The good news with clemastine in this small study is that it appeared to restore lost nerve conduction in the optic nerve. Further, larger studies will determine whether these results are real and result in a meaningful improvement in disability. Research will also confirm that the high doses of clemastine given in this small trial are tolerable and safe. Stay tuned!
Researchers say yoga, aquatic exercise help reduce MS symptoms
A new study of women with MS who are treated with a standard disease-modifying therapy suggests exercise training programs such as yoga and aquatic exercise positively affect fatigue, depression, and paresthesia. The authors claim that exercise training programs should be considered in the future as possible complements to standard treatments. The findings were published in the journal Medicine & Science in Sports & Exercise.
Thrower – It’s hard to imagine a time when people with MS were actually discouraged from exercising. We know now that not only is exercise tolerated by people with MS, but also there are numerous benefits. However, challenges remain. For a person with possible fatigue, weakness, incoordination, mobility issues, and heat sensitivity, the hurdles for getting regular exercise can seem daunting. But, as this study showed, common symptoms like fatigue, depression and tingling all improved with yoga and aquatics programs.
People with MS and their families need to know there is not a “best” exercise. The most effective exercise may be one that a person will stick with and is accessible. Aquatics programs can have advantages such as a reduced likelihood of overheating, falls, and injuries. Yoga can be adapted to almost any level of ability, tends to stretch tight muscles, and improves core strength. If you are having a hard time finding the best exercises for you, think about seeing a physical therapist for guidance or working with a personal trainer.
Study links gut bacteria with MS in kids
A recent study suggests that children with multiple sclerosis had differences in the abundance of specific gut bacteria compared to children without the disease. In particular, there was an association between MS and an increase in gut bacteria linked to inflammation, and a decrease in gut bacteria that are considered anti-inflammatory. A better understanding of gut bacteria’s role in multiple sclerosis may identify novel drug targets and pathways to improved health. The findings were published in the European Journal of Neurology.
Thrower – It’s  been said that the fastest way to a man’s heart is through his stomach. Maybe the same is true for the immune system. Simply stated, there does seem to be a path from our gut to the immune system. Recent research is increasingly pointing to an important link between normal bacteria in our intestinal tract and how our immune system regulates inflammation. While it’s too early to know how to best use this information in our daily lives, this may have great effect on diet, the use of probiotics and maybe even things like the overuse of antibiotics.

New stem cell treatment shows promise

A new study shows the use of chemotherapy followed by autologous hematopoietic stem cell transplantation (aHSCT) has fully halted clinical relapses and development of new brain lesions in 23 of 24 patients with multiple sclerosis for a prolonged period, without the need for ongoing medication. This is the first treatment to produce this level of disease control or neurological recovery from MS, but treatment-related risks limit its widespread use. The results were published in The Lancet.
Thrower – Recently, we’ve seen a flurry of information released about the use of aHSCT for treating MS. The basic idea is to reboot a person’s immune system, with a resultant decrease in the immune attack seen with conditions like MS. Unlike an allogeneic stem cell transplant, where the cells are from a related or closely matched donor, aHSCT in MS is done using the person’s own stem cells. This eliminates the riskof graft vs. host, or host vs. graft disease.
Still, the procedure is not without risk. One of the authors of this study, Dr. Freedman, put together a great paper in 2012 looking at some of risks and benefits of aHSCT in MS (Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned, by Harold L. Atkins and Mark S. Freedman in Neuro-therapeutics). Dr. Freedman points out that patient selection is crucial in aHSCT with the ideal patient being someone with active, inflammatory MS. This may mean active relapses and/or active inflammation on MRI. In this most recent study, people typically were still walking with a walker or better. Frustratingly, the person with longstanding disability, i.e. in a wheelchair for years, may be the person least likely to benefit from stem cell treatment.
FDA approves Zinbryta for use in treatment
The U.S. Food and Drug Administration approved Zinbryta™ (daclizumab) for the treatment of adults with relapsing forms of multiple sclerosis. Zinbryta is a long-acting injection that is self-administered by the patient monthly.
The effectiveness of Zinbryta was shown in two clinical trials. Biogen and AbbVie plan to make Zinbryta available in the third quarter of 2016.
FDA grants priority review for ocrelizumab
The U.S. Food and Drug Administration accepted for review Genentech’s Biologics License Application for Ocrevus™ (ocrelizumab) for the treatment of relapsing and primary progressive multiple sclerosis, and granted the application Priority Review designation with a Dec. 28 targeted action date. If approved, Ocrevus would be the first and only treatment indicated for both forms of MS, which affect approximately 95 percent of people at diagnosis.

Priority Review designation is granted to medicines that the FDA has determined to have the potential to provide significant improvements in the safety and effectiveness of the treatment of a serious disease.
Thrower – More options for managing MS are always welcome. Zinbryta’s (daclizumab) approval this summer introduces a treatment option with a unique mechanism of action. It would also seem to be convenient, with once monthly subcutaneous injections. As with any therapy, the benefits must be weighed against the risks. Zinbryta can be associated with serious liver damage and monthly lab testing is a must. In addition mostly mild skin reactions can be seen. People on Zinbryta need to let their healthcare team know if they are experiencing any new rashes. It’s expected that Zinbryta will be mainly used as a second-line option when other therapies have not worked out.
Ocrevus (ocrelizumab) will likely be FDA-approved for both RMS and PPMS. As stated, this will be our first approved treatment option for PPMS. Ocrelizumab works similarly to rituximab. This drug has been used off-label for both MS and its cousin, neuromyelitis optica. The drug is given intravenously every six months and seems to be generally well-tolerated. The infusion itself is slow, running about six hours on average.