Sir Geoffrey Owen, former editor of the Financial Times, was part of a family living with MS at a time when no effective treatments were available. Since then, great strides have been made in MS research.
Sir Geoffrey has been interviewing top MS scientists to find out where things stand today. In this blog, Sir Geoffrey tells us what 50 years of research into immune damage in MS has taught us.
In 1957, scientists discovered a protein called interferon. Clinical trials showed that a drug based on this protein reduced relapses in MS by preventing immune attacks. The evolution of these treatments since the 1990s is widely regarded as one of the great successes of modern medical science.
As well as leading to new treatments for relapsing MS, the last 50 years of research have helped scientists learn a lot that could help with developing treatments for progressive MS.
1. The importance of drug repurposing
Interferon was initially seen as a possible cure for cancer and only later did scientists begin to explore its relevance to MS. This has been a common experience in MS research.
Cladribine (Mavenclad) was developed for leukaemia but because the drug targets immune cells, scientists began to explore its potential for MS. And alemtuzumab (Lemtrada) came from research looking for a drug to fight organ transplant rejection. Both drugs are now used to treat MS.
Many of the drugs that researchers think may have potential for progressive MS are already licensed for other conditions.
2. The need for patience
We know that it can be a long time between an initial discovery in the laboratory and approval of a drug by the regulators. The development of alemtuzumab as a treatment for MS began in the early 1990s. The drug wasn’t approved for MS until thirty years later in 2015.
The biology of MS is complicated, especially as it varies so much between different people, so it poses some especially difficult challenges for researchers. We wouldn’t have treatments like alemtuzumab without patience from both researchers and funders, and their willingness to keep going during setbacks.
3. The ability to treat active progressive MS
Most existing treatments are only available to people with relapsing MS. But this year, ocrelizumab became the first drug approved for primary progressive MS. The academic community believes that the approval of ocrelizumab opens the door for developing new treatments for progression in MS.
This is because we now know that some people with a diagnosis of progressive MS have immune activity that can be targeted with treatments that target the immune system. A drug called siponimod has even been approved in the US specifically for people with active secondary progressive MS (i.e. they are still experiencing some relapses or have new lesions on an MRI).
4. The feasibility of different treatment approaches
Several of the big advances over the last 50 years relate to not just how effective the drug is in treating MS, but how feasible it is as a treatment.
One such advance was the development of oral drugs like fingolimod (Gilenya). These drugs transformed the treatment of relapsing MS by avoiding the need for injections, so people were more willing to take the treatment.
Another major advance came with the launch of natalizumab (Tysabri), the first monoclonal antibody for MS. This means it targets one component of the immune system while leaving the rest of the system intact, reducing the risk of many side effects.
By building our body of knowledge about how we can tackle the immune aspect of MS, scientists have paved the way for new breakthroughs in the area of MS progression.