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April 29, 2016
The lack of a medication to treat primary-progressive multiple sclerosis (PPMS) is a source of frustration for clinicians and patients. The results of a recent phase 3 study of the drug ocrelizumab may be cause for hope.
An estimated 400,000 Americans have MS, according to the National Multiple Sclerosis Society. Data show approximately 85 percent of individuals diagnosed with MS have relapsing-remitting MS (RRMS) at the time of diagnosis. Inflammation is the hallmark of RRMS, as immune cells launch inflammatory assaults against myelin and nerve fibers. Individuals experience flare-ups of symptoms, followed by periods of remission.
Approximately 15 percent of individuals with MS are initially diagnosed with PPMS. Several factors make PPMS more difficult to diagnose than RRMS, according to Claire Riley, MD, Assistant Professor of Neurology and Director of the Multiple Sclerosis Clinical Care and Research Center at Columbia University. These include fluctuations in the disease course of PPMS that can mask progression, as well as a bias among clinicians toward diagnosing RRMS, which is more treatable than PPMS.
“One factor that makes [treating PPMS] challenging is that we’ve developed a lot of treatments that focus on inflammatory activity,” Dr. Riley says. “While there is some inflammatory activity in people with PPMS, it seems like there are also degenerative changes going on — loss of [whole-brain] volume, loss of neurons. I think these degenerative diseases are much more challenging mechanistically to interfere with. Understanding why particular cells are vulnerable and helping them survive is … a tough nut to crack.”
Researchers also face methodological hurdles.
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