By David Brandes, MD, MS
For 20 years there wasn’t a single medication I could prescribe to help my patients overcome multiple sclerosis, a disease that gradually robbed them of their strength, vision, coordination, and also memory and thinking abilities.
Then, in the early 1990s, everything changed. Interferon beta-1b, a biologic injection, came to clinics. Made of living cells, it was the first medication that could regulate inflammation inside the brain, essentially turning down the abnormal white blood cell activity that caused MS.
Now, nearly 30 years later, there are more than 15 biologic treatment options. They have truly revolutionized the way we treat multiple sclerosis.
There are two ways to approach treating MS using biologics. The first involves reducing the number of flare-ups. These attacks occur when inflammation caused by the patient’s own white blood cells in the brain damages the protective layer around the nerves, called “myelin.” Think of myelin like the rubber coating around an electrical wire. When that coating is missing, the wire – or nerve – is exposed, slowing or stopping the brain’s signals. Patients may experience symptoms such as blurry vision or slurred speech as a result. However, other symptoms such as tingling in the arm, weakness of the leg, impaired bladder control or trouble thinking clearly are also possible.
The second approach involves improving patients’ condition. People with MS have a chronic level of low-grade inflammation in their brain. Even if it doesn’t result in any attacks, the inflammation is still there causing the disease to progress. Biologic medications have been effective at reducing that inflammation, giving patients a better quality of life. One patient of mine, an avid golfer, had to stop playing because of muscle spasms. But after finding the right biologic medication, management of his MS improved and he’s returned to the course.
While there remains no cure for MS, I suspect that treatments will become so advanced in the near future that patients will be able to live without any effects from their condition.
Biologics already do – and will continue to – play a big part in that. Sometimes it takes trying a couple different medications to find the one that works best for an individual patient. But it’s worth the effort if it helps them regain their independence and get back to living their lives. For example, I’ve had patients who, before finding the right treatment, found their vision worsening to the point where they weren’t comfortable driving.
Biologics will continue to shape the future of care for multiple sclerosis, and I look forward to seeing that play out. In the meantime, my patients and I are thankful for the incredible strides made toward managing MS.
David Brandes, MD, MS, is a multiple sclerosis specialist and member of the board of directors for the Southern Clinical Neurological Society, a member group of the Biologics Prescribers Collaborative.