Giving potent drugs to patients who suspect MS can relieve them of debilitating symptoms –

Experts think that giving powerful drugs to patients who are suspected of having multiple sclerosis but have not yet been formally diagnosed could save a life full of debilitating symptoms.

Currently, the most potent drug treatments for the underlying causes of neurological diseases are reserved for more advanced cases.

But a growing body of research suggests that giving such drugs before symptoms worsen could keep the situation stable for at least a decade.

Now, in a world-first study, UK experts will examine whether treating patients as early as possible can prevent some from getting worse.

About 130,000 people in the UK have multiple sclerosis (MS). The disease causes the body’s immune system to attack nerve cells in the brain and spinal cord, gradually leading to problems with movement and vision, muscle spasms, bladder problems, and fatigue. No drugs.

There are several types, but the most common is the condition known as relapsing and remitting MS, which affects about 80% of patients and causes occasional flares of symptoms, sometimes with years of remission.

Most seek medical attention first after a series of hallmark symptoms such as tingling and numbness in the arms and legs. However, it is difficult to make an accurate diagnosis, in part because symptoms can come and go.

Doctors perform brain scans to look for early signs of nerve damage in the brain and lumbar puncture to analyze spinal fluid for signs of MS-related damage.

Some patients will have several visible lesions – dark or light scars (sclerosis) in the central nervous system that look different from normal tissue – but others may develop them later.

Having an injury increases someone’s chances of getting MS by 80%.

Patients in the new study will be given a low-risk drug called natalizumab before their diagnosis is confirmed to see if it can benefit those in the early stages of the disease.

Professor Klaus Schmierer, neurologist at Barts Health NHS Trust in London and Queen Mary University in London, plans to recruit 40 patients visiting their GP or emergency room with symptoms suggestive of MS. All will go through MRI scans to check for at least one brain injury.

Twenty volunteers whose symptoms started within the last 14 days will receive natalizumab every four weeks for a period of six months. It works by preventing the fighting cells of the immune system from reaching the brain and spinal cord and attacking the nerves.

prof. Previous work by Schmierer and colleagues suggests that some of these cells may trigger the inflammation that occurs in MS.

The drug stays in the body for only eight weeks, while others can stay for 18 months or more, so if patients with brain damage but not MS are 20% or more, patients may recover from it. there is no risk of side effects. long-term.

The other 20 patients will receive placebo for 12 weeks before switching to natalizumab for the remainder of the study.

NHS England will fund all patients to continue taking the drug after the trial ends.

In the first worldwide study, UK experts will examine whether treating patients as early as possible can prevent some from getting worse (archive image)

Experts say it effectively treats MS in the same way as stroke, and treatment is started right away without waiting for a definitive diagnosis. The scientists say the new field of research points to a “mindset” in understanding how the condition develops and how it can be treated.

He suggests that the microscopic damage the disease causes in the brain and nervous system begins very early and plays an important role in the course of the disease.

Dr. Emma Gray of the MS Society charity described the work, which will begin in September, as “very exciting.”

“We noticed that elements of MS progression start at the very beginning of the disease,” says Prof. Schmierer.

“In the early stages, the brain still has reserve capacity that can help restart connections that MS may have damaged. So if we start treatment early rather than wait, could it really offer patients a better chance for long-term remission? It’s huge in patients’ ‘quality of life’. It could mean a change.

The new study follows up on research that suggests this approach could work. An Australian article published in the Lancet in April 2020 found that patients who start using the drugs within the first two years of diagnosis, but not in the early stages, are less likely to see their disability worsen. Ten years later, patients who took the drugs early saw little change in their condition.

Two women who understand the importance of early treatment are sisters Vikki Langford and Zoe Bowman, who were diagnosed with MS within weeks in 2017.

While Vikki was able to start treatment in a few weeks, Zoe, who has a less common form of MS that progresses without remission, had to wait nine months.

Vikki, 56, from York, said: “Time is always of the essence. While we don’t know what would have happened if Zoe had access to treatment earlier, her symptoms got worse while she waited.”

In a separate study, Prof. Schmierer plans to use artificial intelligence technology to analyze MRI scans of people with multiple sclerosis to see if it can more accurately detect new lesions or changes in lesions over time.

MRI results are critical to the type of treatment patients receive, but interpretation of scans takes a long time for radiologists because they need to be compared in detail with previous scans to find anything new or different.

It is hoped that trials among many will be based on a new clinic.

Research facility at Royal London Hospital, part of Barts Health NHS Trust.

Located on the 15th floor in a former covid intensive care unit, the renovated facilities are funded by Barts Charity as part of Barts 900, a campaign to celebrate the 900th anniversary of the founding of the original St Batholomew Hospital.

The world-class facility will develop innovative new treatments and strive for greater diversity in clinical trials. At least half of the participants will be black or Asian to best represent the diverse population of the East London hospital, where two-thirds are from ethnic minorities.

These communities are less likely to be involved in medical research. But addressing this discrepancy is crucial because some diseases may have different risks and often respond slightly differently to treatments.

For example, MS is more common in people who live further from the equator.

A 2017 study of the East London population found that people who moved to the UK from MS rare communities, particularly East Asia, Southeast Asia and Africa and the Caribbean, increased their risk of MS, so vitamin D and UV combined with other environmental factors can play a role. People of Asian descent may be more severely affected.

However, most MS studies have been predominantly conducted in Caucasian populations.

“We don’t know if the treatments also work for people belonging to ethnic minorities, so we hope to find indicators in this regard in our studies,” says Prof. Schmierer.

CRF has yet to be launched, but the goals are ambitious. Other planned studies include studies on how different ethnic groups respond to blood pressure medications, cardiovascular disease, diabetic kidney disease, and chronic obstructive pulmonary disease. Another intensive care doctor plans to address muscle wasting in intensive care patients.

There will be beds for overnight stays and special consultation rooms for gene-editing treatments.

ICU consultant Rupert Pearse, who will lead the new unit at Royal London, said: “The aim is to improve the health of our local population by encouraging more people to participate in trials and by building trust in communities where they may be less likely to get in touch with health professionals.

“We know that there are differences in health outcomes among Black, Asian, and White communities, and we want at least half of trial participants to come from traditionally underrepresented groups.”

“It can really make a big difference and help us treat and better understand a range of diseases.”