In MS, the immune system becomes confused and attacks the protective myelin coating around our nerves. If our body can’t repair the damage, then the nerves can’t communicate properly and may eventually die.
What goes wrong with the immune system in MS?
The immune system is your body's defence against infection. Autoimmunity is when the immune system attacks normal body tissues by mistake. In MS, the immune system treats the protective myelin coating around nerves like an infection. This leads to myelin being destroyed and the nerve not working properly.
Can we stop immune attacks in MS?
We do not know why the immune system starts to go wrong in MS. Because of this, the majority of disease modifying therapies (DMTs) look at influencing the level of immune cells in circulation, with aim to help to reduce the frequency of immune attacks.
We know that vitamin D plays a role in immune system function. But, the science isn’t clear whether influencing vitamin D levels will be beneficial for people with MS.
How do Disease Modifying Therapies (DMTs) work?
DMTs work by changing how the immune system behaves. They reduce the number of circulating immune cells in the blood by either removing them from the body or ‘trapping’ them in specific areas of the body. This can make it less likely for attacks to occur to the nerves in the brain and spinal cord. Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your own blood stem cells.
Although DMTs work by helping to control immune attacks, they do not directly aid in myelin repair.
Can Disease Modifying Therapies (DMTs) stop progression?
DMTs are not a cure for MS, but they can reduce the frequency and severity of relapses and can help reduce some of the symptoms in those with relapsing MS. Recent research also shows that DMTs can even help to slow the progression of relapsing MS and extend life expectancy. But current DMTs only work on the immune system, so cannot slow underlying progression in more advanced MS.
Why is early treatment important?
In October 2014, a study looked at 3,060 people with MS and the long-term risk of disability. The researchers found that DMTs delayed long-term disability in people with MS and were more effective at doing so when used at the early stages of the condition. Thus, early treatment is considered to be better than late treatment, but late is better than never.
In England, 56% of those who could potentially benefit from taking a DMT were doing so in 2016, even though there are multiple benefits to their use. The CARE-MS II trial, in 2016, showed that early treatment with more intensive therapies – which have more side effects – may be beneficial for MS. Research led by Professor Neil Robertson, which showed that early intensive treatment with DMTs lead to better disability outcomes over 5 years, than less intensive, first line DMTs.
This adds to the growing body of evidence that early treatment intervention leads to better outcomes for people with MS.
- Current research