Multiple Sclerosis and Chemotherapy

Question

I caught part of a cable television program but I ended up falling asleep but it seemed interesting (I was just exhausted). Basically it talked about chemotherapy being a so-far proven treatment for Multiple Sclerosis (not sure at what stage or where in the world it was).

I did some searches on the search function on Health.SE and I couldn't find anything on the topic of MS and chemotherapy as a treatment so I figured I'd ask here to see if others can put out some good information on it.

Question

Is there any truth behind chemotherapy actually curing Multiple Sclerosis (short-term or long-term) that's been done to humans? Are there any specific facilities, clinical trials, treatment centers, etc. that one with this condition may use for a good starting point about availability to them.

Answer 1

Is there any truth behind chemotherapy actually curing Multiple Sclerosis?

Unfortunately, no. Multiple sclerosis (MS) is a chronic illness - meaning that it cannot be completely cured. There are, however, various therapeutic options for patients suffering from MS. Some of them include chemotherapeutics - but not as the first-line treatment.

The important thing to understand is that there are many forms of MS, which can roughly be categorised in four groups:

1. Relapsing - remitting (RR)
2. Primary progressive
3. Progressive relapsing
4. Secondary progressive

Severity, clinical manifestations and treatment options differ across these types. The most common type is RR.

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RR therapeutic approach

For RR there are two sorts of treatment:

1. Treatment in an acute relapse, where short-term corticosteroid treatment is used to stop the attack
2. Disease modifying treatment - which is used regularly in order to reduce the frequency and severity of relapses, and improve prognosis.

It is the second group, where chemotherapy can be used, but, as mentioned above not as a first-line treatment. This means that other therapeutic options should be tried first. These are predominantly glatiramer acetate or interferon beta. If they don't work some other medicines are considered. Only if they don't work either, the next option is using chemotherapeutic agents.

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How would a chemotherapeutic work in MS?

There are, again two approaches. The first one is to use these medicines, at lower doses than to treat cancer, to suppress the immune system. Since MS is an autoimmune disease, immune suppression reduces the inflammation and damage to the myelin sheet. Another approach is to use these medicines to ablate the immune system prior to autologous stem cell transplant, where the patient's bone marrow is replaced with their stem cells. This line of treatment is, however, still in experimental phase and has not been approved. There are many complications, difficulties and side-effects of this procedure, and thus far the risks outweigh the benefits.

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Examples

Some sorts of chemotherapeutic agents that have been used or tested for MS:

• Cladribine has been tested for MS and even approved in some countries, but after it was rejected by the FDA and EMeA on the basis of lacking evidence for benefits outweighing the risks, the manufacturer stopped marketing applications, since new clinical trials would be costly.

• Cyclophosphamide has also been investigated. Efficacy in aggressive form of disease was reported, but so were some serious adverse effects. Further research in necessary, and official guidelines, such as those by the National Institute for Health and Care Excellence (NICE) do not recommend use of cyclophosphamide in MS treatment.

• Methotrexate has shown no significant efficacy in primary progressive MS, and was less effective than interferon beta in RR.

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References:

_{Drug Therapies for Relapsing-Remitting Multiple Sclerosis}

_{Recommendations for Drug Therapies for Relapsing-Remitting Multiple Sclerosis}

_{Multiple Sclerosis: A Primary Care Perspective}

_{Treatment Optimization in MS: Canadian MS Working Group Updated Recommendations}

_{A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis}

_{Merck: Regulatory Update on Cladribine Tablets}

_{Interventions affecting disease progression: cyclophosphamide should not be used in patients with multiple sclerosis (because research evidence does not show beneficial effects on the course of the condition).}

_{Effects of low dose methotrexate on relapsing-remitting multiple sclerosis in comparison to Interferon β-1α: A randomized controlled trial}

_{Methotrexate for multiple sclerosis}

_{Hematopoietic stem cell therapy for multiple sclerosis: top 10 lessons learned.}