Masters of Neurology: Avoiding MS Treatment Failure –

  
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Timothy Vollmer, MD, on treatment failure rates among first- and second-generation MS drugs


March 01, 2017


Timothy Vollmer, MD, of the University of Colorado Anschutz Medical Campus, spoke with MedPage Today at the European Committee for Treatment and Research in Multiple Sclerosis annual meeting in September, where he presented several posters on treatment failure rates for first- and second-generation disease-modifying drugs in MS. Two full posters may be downloaded by clicking here and here.


Following is a transcript of his remarks.


The issue that led to these reports was a concept that we’ve been working on for a number of years called “Maximizing Lifelong Brain Health in MS.” By that, we mean using these disease-modifying therapies to try to minimize injury in the brain as early in the disease course as we can, as well as helping patients to adopt a healthy lifestyle such as a good, healthy diet to avoid diabetes, hypertension, and other diseases that further increase disability in MS and also to help them adopt an active lifestyle because we know that exercise improves function in multiple sclerosis.

This concept of maximizing lifelong brain health comes out of a growing concept called “neurological reserve.” In multiple sclerosis, about 90% of new lesion formation in the brain is actually clinically silent at the time that it occurs. The brain is compensating for this injury, and the injury actually is leading to not only demyelination, but also loss of neurons and accelerated shrinkage of the brain, or loss of brain volume.

The ability of the brain to compensate for that injury, that sub-clinical injury where the patient actually feels like they’re functioning normally and they don’t notice any loss in function, is neurological reserve.

The capacity to compensate for subclinical injury, however, is limited and there’s a growing consensus in the field that the cause of the progressive phase of MS actually may be the point where the brain has used up that neurological reserve and now it doesn’t have neurological reserve to buffer for the sub-clinical disease activity. At that point, it’s also unmasked by the effects of aging. We begin to have our brain shrink, all of us, at around age 35, and yet we don’t notice the effects of aging usually until later in life. So preserving brain volume in early disease for MS patients is not only important for the MS disability. It’s also important to minimize the age-related changes that we’re all going to suffer as we go forward.