I have no objection to people forming their own opinions about MS - I just can't form one given all the theories and the limited amount of data supporting them.
In many ways the current options open to us are limited. If one believes that MS is a neuro-degenerative disease where inflammation is a secondary response, then there are no drugs currently available which will help. In my case I was experiencing bad relapses and Rebif seemed to have little effect. I had the chnace to go for a more toxic but more effective drug (Campath) and took this opportunity. This drug has worked wonders in terms of shutting down the inflammatory activity and I am certainly better than 12 months ago (measured by MRI, EDSS and my own assessment comparing what I did then and do now). So this drug has helped with the reversible
disability (I don't have irreversible disability that I am aware of). What effect this drug will have in 3 / 5 / 7 years - I do not know. But the current is what I am focussing on. There are trials of neuro-protective drugs (e.g. sodium channel blockers) which may well be prescribed in 2-3 years time. Beyond that I look to treatments which might promote repair.
At the AAN conference Dr Coles is presenting Campath 1-H trial results. I confess I am a big fan as he is my neuro. He recognises that the big questions have still to be answered as illustrated in the following answer to another of my questions:
I am a recipient of Campath 1-H (last November) and am so far thrilled with the results. I would be grateful for your thoughts on the following:
(i) Campath 1-H appears to offer most advantage early in the disease for those with Relapsing / Remitting MS. How long will it be before any conclusions can be drawn as to whether or not Campath 1-H offers long-term benefits to these patients (as when Campath 1-H was used on those with Secondary Progressive MS, relapses and inflammation were reduced but, over time, the progression of disability continued)?
(ii) Much research is being undertaken into neuro-protective agents, such as minocycline and cannabis extracts. If agents offering neuro-protective benefits are identified, might these offer a sensible add-on therapy to Campath 1-H, given that the latter primarily targets the inflammatory process in MS?
(iii) Some MS researchers have suggested that inflammation is a secondary response rather than the initiating process in MS. Is the research into Campath 1-H going to provide some insights as to whether MS is an inflammatory disease which results in neuro-degeneration, or a neuro-degenerative disease which (for some patients) then leads to an inflammatory response?
Thank you for your post.
i) As with all drugs in multiple sclerosis, it takes a “long time” to get “long-term” data! But it is this information that is so important. We have already published anecdotal data on people with multiple sclerosis who had Campath-1H up to five years ago. But we only have rigorous clinical trial data for two years of Campath-1H treatment. Later this year we will have three-year data… and so it goes.
ii) I agree. I think the ideal treatment strategy for multiple sclerosis will be drugs that are safe enough to take really early on in the course of multiple sclerosis and that combine both anti-inflammatory and neuroprotective actions.
iii) A good point. I think that the long-term effects of drugs like Campath-1H will tell us whether inflammation is the driving force behind multiple sclerosis (in which case we should see a good outcome) or just a secondary response (in which case there will be no long-term benefit).
Hope that helps
While he's keen to see Campath be a successful treatment, he fully recognises that only time will tell. He and my other neuro Professor Giovannoni give me some confidence in the sytem. Professor G is working on treatments for the progressive stage of MS where current treatments are pretty hopeless.
All the best