Thursday, September 24, 2009
Drugs in My Pocket
Even though we have a great number of drugs currently in different phases of clinical trials, our best offense against MS is still the 4 current DMDs (disease modifying drugs). Over the past decade, researchers and the drug companies have continued with Phase 4 observational studies and from the information gathered they have made the drugs easier to take.
For many of us on Avonex, the side effects are well tolerated with the addition of acetominaphen or ibuprofen. When 8 hour arthritis Tylenol came on the market, we finally got a full night's sleep on the evening of our shot. Biogen Idec has also come up with pre-filled syringes and smaller needles to make shot taking a little less daunting. There have also been some changes in Rebif to make things easier.
The DMDs are creating a "new" natural history of MS; time to progression to disability is increased by 4 years. For example, someone with MS might take 15 years to progress to disabled without DMDs, but someone with MS taking one of the drugs would take 19 years.
The medical community have recently (in the past 8 years) modified diagnostic criteria for MS so we are now seeing earlier diagnosis of MS. Before these changes, it could take 6-8 years for a positive diagnosis. Now it's 6-8 months. That means that people with MS can be treated earlier with one of the DMDs, as early as the first clinically isolated syndrome (CIS). We now have the ability to modify the course of MS by treatment of CIS.
What we have come to discover is that these DMDs don't work for all MS patients. So now the researchers are focusing on what is different between patients and trying to come up with ways to identify those that will do well on the DMDs and those who won't. I'm one of the patients participating in one of these studies.
For those who don't tolerate the DMDs, there are a great number of drugs in the pipeline. One was mentioned by a commenter on my last post, teriflunomide. This drug is showing promise so far and if added to a regime of an interferon (Avonex, Betaseron, or Rebif), shows even greater results. It should be noted that the drug has been used to treat rheumatoid arthritis since 1998 and does have some serious side effects. There are a number of Phase 3 trials going on right now.
Tysabri is already on the market as a treatment for MS. This, like teriflunomide, is an immunosuppresant. The very feature that makes it good for MS, can also leave you succeptable to PML, an infection caused by the JC virus, a common virus that usually lays dormant in our system. If our immune system becomes compromised or suppressed, the JC virus may become active and can result in death. It's extremely rare and now that it has come to the attention of the medical community, patients are screened even more carefully before being given the drug and must be registered for monitoring.
In my next post, I'll give you some more drugs currently being studied.