Giving powerful drugs to patients who have suspected multiple sclerosis could spare them lifetime of debilitating symptoms, experts believe
- People with multiple sclerosis (MS) face a worsening symptoms as years go by
- The debilitating conditions leads to mobility, muscle, bladder and eye problems
- Experts believe people who have not been formally diagnosed could be treated
- A new drug is being tested on those in the early stages of the incurable condition
Giving powerful medication to patients suspected of having multiple sclerosis – but who are not yet formally diagnosed – could spare them a lifetime of debilitating symptoms, experts believe.
At present, the most potent drug treatments that tackle the underlying causes of the neurological disease are reserved for those with more advanced cases.
But a growing body of research suggests giving these types of medicines before symptoms worsen could keep the condition stable for at least a decade.
Now in a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place.
Some 130,000 people in Britain have multiple sclerosis (MS). The disease causes the body’s immune system to attack nerve cells in the brain and spinal cord, which gradually leads to mobility and eyesight problems, muscle spasms, bladder issues and fatigue. There is no cure.
A growing body of research suggests giving some types of medicines before symptoms worsen could keep the condition stable for up to a decade (stock image)
There are several types, but the most common is what’s known as relapsing and remitting MS, which affects roughly 80 per cent of patients and causes symptoms to flare up sporadically, sometimes with years of remission in between.
Most first seek medical help after experiencing a period of telltale symptoms, such as tingling and numbness in the arms and legs. But getting an accurate diagnosis is challenging, partly because symptoms can come and go.
Doctors perform brain scans to look for early signs of nerve damage in the brain, and a lumbar puncture to analyse spinal fluid for signs of MS-related damage.
Some patients will have several visible lesions – dark or light spots of scarring (sclerosis) in the central nervous system that appear different from normal tissue – but others may develop these later.
Having one lesion makes it 80 per cent likely someone has MS.
Patients in the new study will be given a low-risk drug called natalizumab before their diagnosis is confirmed, to see if those in the earliest stage of the disease can benefit.
Professor Klaus Schmierer, a neurologist at London’s Barts Health NHS Trust and Queen Mary University of London, plans to recruit 40 patients who have visited their GP or A&E unit with symptoms which suggest MS. All will undergo MRI scans to check for at least one brain lesion.
Twenty volunteers, whose symptoms began within the last 14 days, will be given natalizumab once every four weeks over six months. It works by stopping the immune system’s fighter cells from reaching the brain and spinal cord and attacking nerves.
Earlier work by Prof Schmierer and his colleagues suggests some of these cells may drive the inflammation which occurs in MS.
The drug stays in the body for only eight weeks – while others can remain for 18 months or more – so if patients are among the 20 per cent or more who have a brain lesion but do not have MS, they can come off it without risking long-term effects.
The other 20 patients will be given a placebo for 12 weeks, before being transferred onto natalizumab for the remainder of the trial.
NHS England will fund all patients to stay on the drug after the trial ends.
In a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place (stock image)
Experts say this effectively treats MS in the same way as a stroke – starting treatment almost straight away, without waiting for a definitive diagnosis. Scientists say the new field of research marks a ‘change of mindset’ in the understanding of how the condition develops and how it can be treated.
It suggests that the microscopic damage to the brain and nervous system caused by the disease starts very early, and plays an important role in how the condition progresses.
Dr Emma Gray, at the MS Society charity, has described the research, which will begin in September, as ‘really exciting’.
‘We’ve realised that elements of MS progression start with the onset of the disease,’ Prof Schmierer says.
‘In the early stages the brain still has the reserve capacity which can help reboot the connections that MS might have damaged. So if we start treatment early rather than waiting, might it give patients a better chance of really long-term remission? It could represent a huge change in quality of life for patients.’
The new study follows research which provides clues that this approach might work. An Australian paper published in the Lancet in April 2020 showed patients who started taking the drugs within the first two years after diagnosis – but not in its earliest stages – were less likely to see their disability worsen. After ten years, the patients who took the drugs early barely saw their condition change.
Two women who understand the importance of early treatment are sisters Vikki Langford and Zoe Bowman, who were diagnosed with MS within weeks of each other in 2017.
While Vikki was able to start treatment within weeks, Zoe, who has a less common type of MS which progresses without remissions, had to wait nine months.
Vikki, 56, from York, said: ‘Time is always of the essence. While we don’t know what would have happened if Zoe had got earlier access to treatment, her symptoms worsened while she was waiting.’
In a separate study, Prof Schmierer plans to use Artificial Intelligence technology to analyse the MRI scans of people with multiple sclerosis, to see if it can more accurately detect new lesions, or changes to lesions over time.
MRI results are critical to the type of treatment patients are given, but interpreting the scans is time-consuming for radiologists as they have to be compared, in great detail, to previous scans to find anything new or different.
It is hoped the trials will be among many to be based at a new Clinical
Research Facility at the Royal London Hospital, part of Barts Health NHS Trust.
Housed on the 15th floor, in former intensive care wards for covid patients, the revamped facilities are funded by Barts Charity as part of Barts 900, a campaign to mark the 900th anniversary of the founding of the original St Batholomew’s Hospital.
The world-class facility will develop innovative new treatments and aims to include more diversity in clinical trials. At least half of participants will be Black or Asian to better represent the hospital’s diverse East London population where two thirds are from minority ethnic communities.
These communities are less likely to get involved in medical research. But addressing this discrepancy is crucial because their risk of certain diseases may be different, and they often respond slightly differently to treatments.
MS, for example, is most prevalent in people living furthest from the equator.
A 2017 study on the East London population found people who move to the UK from communities where MS is rare – particularly East Asia, South East Asia and Africa and the Caribbean – increase their risk of MS, which suggests reduced exposure to vitamin D and UV, along with other environmental factors, may play a role. People with an Asian background may be more severely affected.
Yet most studies on MS have been carried out in predominantly white populations.
‘We don’t know whether treatments work as well on people in minority ethnic groups, so we hope to find clues to that in our work too,’ says Prof Schmierer.
The CRF hasn’t opened yet but its aims are ambitious. Other planned work includes how different ethnicities respond to blood pressure drugs, studies in cardiovascular disease, diabetic kidney disease, and chronic obstructive pulmonary disease. Another intensive care doctor plans to tackle muscle wastage in ICU patients.
It will have beds for overnight stays, and specialist consulting rooms for gene editing treatments.
Rupert Pearse, an intensive care consultant at the Royal London who will lead the new unit, said: ‘The aim is to improve the health of our local population by encouraging more people to take part in trials and building up trust with communities who might be less likely to engage with health professionals.
‘We know there are differences in health outcomes between Black, Asian and white communities and we want at least half our trial participants to come from traditionally under-represented groups.
‘It could really make an enormous difference, and help us to better treat and understand a whole range of diseases.’