- A new study has found that a drug called teriflunomide may delay the first symptoms of multiple sclerosis for people whose MRI scans show signs of MS.
- The researchers found that the drug can help even if people affected are not yet manifesting symptoms of the disease.
- MS is a disease that affects the brain and spinal cord. In MS, the immune system attacks the protective coating that covers the nerve fibers, called myelin.
Starting treatment early for multiple sclerosis (MS) may delay the onset of the condition, according to new research. A study conducted at the University Hospital of Nice in France has found that a drug called teriflunomide may delay the first symptoms of MS for people whose MRI scans show signs of MS, even though they are not yet manifesting symptoms of the disease.
The condition that shows up on MRIs is called radiologically isolated syndrome and it is diagnosed in people who do not have MS symptoms, but do have lesions in the brain or on the spinal cord, similar to those seen in MS. Sometimes these patients go on to develop MS, even though radiologically isolated syndrome is a separate condition.
“Teriflunomide is not a new drug,” said Dr. Tyler Smith, a neurologist specializing in MS at NYU Langone Comprehensive Multiple Sclerosis Care Center. “We use it all the time to treat MS. What this study is saying is that maybe we can diagnose MS before symptoms start and maybe a medication like this could be used reasonably safely to keep patients from developing symptoms.”
The preliminary study, to be presented at the American Academy of Neurology’s 75th Annual Meeting, involved 89 people with radiologically isolated syndrome. Half of the people were given teriflunomide daily and the other half were given a placebo. Both groups were followed up for up to two years.
The results found that eight people who took teriflunomide developed MS symptoms, compared to 20 who took the placebo and developed MS symptoms. This shows that the drug lowered the risk of experiencing first symptoms by 72 percent.
“The findings make a lot of sense,” added Smith. “If we have someone who is presymptomatic, in other words it looks like they have MS based on an MRI, and we give them a drug that keeps them from developing new symptoms, it makes sense. The goal is to diagnose MS earlier and earlier. It’s not a new drug, it’s just been administered earlier than we would normally.”
“I don’t think [this study] is anything that novel,” said Dr. Asaff Harel, director of the Multiple Sclerosis Center at Lenox Hill Hospital. “We know that our treatments are likely to work even in very early MS, and even in MS that has not caused symptoms yet.”
Multiple sclerosis is a disease that affects the brain and spinal cord. In MS, the immune system attacks the protective coating that covers the nerve fibers, called myelin. This disrupts communication between the brain and the rest of the body, eventually leading to permanent damage or deterioration of the nerve fibers.
Symptoms of MS vary, but can include the following:
- Numbness or weakness in one or more limbs
- Electric-shock sensations that occur with certain neck movements
- Lack of coordination
- Difficulty walking
- Vision problems including double vision, partial vision loss or blurriness in one eye
- Problems with bladder function
- Cognitive problems
Teriflunomide is a medication that doctors have been using to treat MS for many years. It works to inhibit the function of immune cells that have been affected by MS. It helps to prevent new lesions on the brain and spinal cord, which can delay the onset of symptoms.
The difference is that this study gave the drug to patients before they were diagnosed with MS. Instead, what they were diagnosed with is radiologically isolated syndrome (RIS). RIS looks similar to MS in an MRI, but they are asymptomatic. Therefore, if a person’s MRI shows up with these lesions, it could potentially lead to a misdiagnosis of MS, when in reality a person has RIS.
“The barrier [to this study] is to ensure we are not misdiagnosing anyone early. Making that diagnosis can sometimes be difficult and somebody may be prescribed this drug and on it for 30 years, but it may not necessarily be a medicine that they need,” said Smith.
The issue, however, is that if the lesions are pre-MS, it’s better to catch it early because once MS symptoms start, you cannot go back and correct them.
“I think the question is still who needs this treatment and who does not,” added Harel. “We don’t have a great way of predicting, at the person by person level, who will go on to develop symptoms. Therefore, even though it’s effective at the group level, it is still unclear whether it’s worth using, because some people with RIS do not end up developing symptoms of MS.”
“Otherwise, though, preventing damage before it occurs is great. The earlier we can diagnose, the better. It’s just about trying to find the balance between misdiagnosis versus early, accurate diagnosis,” said Smith.