Believe it or not, until 1993 there was no treatment available for multiple sclerosis (MS), with doctors turning to steroids to manage patients’ symptoms. But over the past several years, there's been an influx of new disease-modifying agents for MS, which affects more than two million people worldwide.
"When MS therapeutics were new, there was a tendency to start with lower potency medications and escalate to a higher potency agent only if the patient with MS continued to worsen,” Dr. Ellen Lathi, director of the Elliot Lewish Center in Wellesley, Mass., told Fox News. “Now most MS specialists believe that it is best to start more potent medication earlier in the disease in many patients to avoid future disability. We know that once disability occurs, we can do little about it; it is best to treat as aggressively as needed to avoid this disability.”
Jud Ehrbar, of Manhattan, was diagnosed with relapsing-remitting MS nearly 20 years ago. At the time, the now-47-year-old was a drummer in a band, and had started teaching math in public school. He eventually sacrificed both as his symptoms worsened over the years.
"Eating was a huge problem, cutting food, tying shoes, putting on clothes, just anything that requires the littlest bit of dexterity in your fingers,” Ehrbar told Fox News. “I just couldn't do it anymore."
The father of two says his illness has been unpredictable, making it difficult to plan activities with his kids.
"It's hard to think about my kids getting older and what I’ll be doing with them and looking forward to different milestones when I don't know how I’m going to be doing at that point, even a year from now," he said.
Ehrbar has tried many treatments including injections once per week, infusions once per month and recently pills, which he takes twice daily. They're meant to keep him in remission, but he said he still has symptoms and now relies on a scooter to get around.
Mike Logan, a 48-year-old broadcaster and teacher in Boston, has a story similar to Ehrbar’s.
He was diagnosed in 1993 and struggles with mobility and balance, and also has bladder and bowel issues. He said his doctors believe he has the progressive form of MS, but he didn’t need to take medications until 2015.
“My condition had started to worsen over the last two years, and I was looking for anything that might slow the progression of the disease,” Logan said.
He enrolled in a clinical trial for a now-FDA-approved drug called Ocrevus by Genentech, Inc. The drug is administered in a three-hour infusion just twice per year.
The drug works by attaching to a unique population of lymphocytes, and then depleting them from the body, Dr. Brian Apatoff, a neurologist at New York-Presbyterian Hospital in New York, told Fox News. In doing so, it keeps the cells out of circulation so that it doesn’t activate immune responses in the nervous system.
Ocrevus is the first treatment approved for both forms of MS. In Logan’s portion of the trial, 488 patients were studied. It found patients were 24 percent less likely to have worsening symptoms compared to those who took a placebo.
“This is significant because before this, there was no medication that had showed any benefit for people with primary progressive MS,” Lathi said. “The most common adverse reactions in the PPMS trial -- incidence ≥10 percent -- were upper respiratory tract infections, infusion reactions, skin infections, and lower respiratory tract infections.”
Logan said he didn’t have any side effects but also hasn’t seen any improvements.
“I still struggle walking on a daily basis and have started using a cane to help me get around,” he said. “I'm encouraged by the fact that Ocrevus may be able to slow down any further progression and maybe I will see some improvements in the near future.”
Once the drug gained FDA approval in March 2017, Ehrbar also got the treatment with hopes of reducing frequency and severity of relapses.
"It's given me some hope that I just never had before,” Ehrbar said. “Like I said, it was always about trying to prevent something from happening, having a better chance of maybe stopping something, whereas with this treatment, I feel like it's probably going to stop things from getting worse completely."
Apatoff said the results so far have been encouraging.
“We were able to show that with this very infrequent administration, patients were able to achieve a level of remission that we didn't see with the other active comparator in this study,” he said.
Risks of the treatment include infection and development of certain types of cancer including breast cancer. It is not recommended for patients who have active hepatitis.
“In choosing a medication for each patient, either at the time of diagnosis or at a later time in the disease, we must constantly balance the risk (safety) and benefit (efficacy) of each medication as it relates to the risk MS poses to an individual patient,” Lathi said.