One year ago, OhioHealth became the first healthcare provider in the U.S. to administer the new drug ublituximab (brand name Briumvi), increasing the accessibility of treatment for individuals with multiple sclerosis (MS). OhioHealth’s Multiple Sclerosis Clinic was also the first in the world to administer the medicine Ocrevus in 2017.
In recognition of Multiple Sclerosis Awareness Month this March, Jacqueline Nicholas, system chief of neuroimmunology and multiple sclerosis and director of MS research at OhioHealth, talks about the challenges of getting a diagnosis, as well as available treatments.
Types
Multiple sclerosis is an autoimmune disease in which the immune system randomly attacks the central nervous system, including the brain, spinal cord and optic nerves. Since this system controls our body’s functions, damage from attacks can lead to symptoms such as fatigue, numbness, imbalance, blurry vision, and troubles with bladder and bowel control.
MS often presents between the ages of 20-40 years old, though about 5 percent of cases show up in childhood, Nicholas says.
Courtesy of OhioHealth
The OhioHealth Neuroscience Center
One key factor in diagnosing MS is ruling out all other possible alternative diagnoses. The common symptoms of MS can correlate to vitamin deficiency, infections or other autoimmune conditions, so it is important to identify the cause to know how to best treat the patient. Some ways to screen for MS include blood tests, MRI brain imaging and lumbar puncture.
The most common form of the disease is relapsing-remitting, in which individuals experience episodes of their symptoms. Between the two main types, Relapsing-Remitting MS (RRMS) and Primary Progressive MS (PPMS), Nicholas says, 85 percent of MS patients are diagnosed with RRMS. This is usually the case as the first physical symptom patients experience can sometimes last for hours or days, whereas patients with PPMS usually see their symptoms gradually worsen over time.
However, these diagnostic labels may change in the future, as experts believe that MS is a singular disease that can present in different ways based on its progression.
Treatment options
One of the drawbacks of current MS treatments is they cannot fix the damage already done to the brain and spinal cord.
However, before the 1990s, treatment for MS did not exist and little was known about the condition. Advocacy from loved ones and organizations such as the National Multiple Sclerosis Society and the Multiple Sclerosis Association of America have helped scientists make tremendous strides related to research and care.
Today, there are more than 20 treatments available, including at-home shots, oral pills and IV infusions. Most treatments target RRMS and build on previous treatments to be more convenient, effective and tolerable for patients.
Courtesy of OhioHealth
Jacqueline Nicholas
Dr. Jacqueline Nicholas is the System Chief of Neuroimmunology and Multiple Sclerosis and Director of MS Research at the OhioHealth Multiple Sclerosis Center
Ocrevus, the drug OhioHealth was the first to administer in 2017, is the only FDA-approved treatment for PPMS.
The latest drug, Briumvi, is another IV infusion for RRMS.
Though previous treatments required monthly, hour-long infusions with an hour of monitoring or, less frequently, two- to four-hour infusions, Briumvi is administered as an hour-long infusion every six months.
“That treatment, ublituximab, is exciting for people with MS because it’s what we consider to be highly effective. It’s very effective at preventing new attacks and new damage on MRI, but also really important is it’s not time-consuming,” Nicholas says. “Many of our patients are parents, they are working, so to have to go in and spend a long time in a doctor’s office or in an infusion center to receive medication can be really hard. This makes it much more convenient.”
In addition to any medication a patient may be taking, Nicholas emphasizes exercise as an effective treatment for maintaining brain health and wellness, even in small amounts.
“It’s really important that somebody has those opportunities (to get active), – that they get to go to physical therapy to learn what can they do with the physical abilities that they have to maintain that long-term health and function,” Nicholas says.
Demographics
There is a prevalence of 1 million people with MS in the United States, affecting the various demographics of this population differently.
Women with MS outnumber their male counterparts three-to-one, Nicholas says, though men are more likely to have a worse prognosis. Hormones are linked with the prevalence of MS in women, as the statistics of MS in women triples after puberty, and cycling hormone levels affect the pro-inflammatory markers of MS.
Non-caucasian demographics, such as Black and Hispanic populations, have a higher risk of a more aggressive course of MS, though these populations are often underrepresented in clinical trials and it is hard to predict the prognostic factor.
Rare Types of Multiple Sclerosis
- Clinically Isolated Syndrome: potential precursor to MS, as the individual has experienced a symptomatic episode but does not yet meet all the criteria of MS
- Progressive-Relapsing MS: occurs when individuals experience a gradual worsening of the condition and episodes
- Radiologically Isolated Syndrome: occurs when abnormalities appear in an MRI that may or may not develop into MS
- Secondary Progressive MS: neurological function worsens over time and disability increases
Jane Dimel is an editorial assistant at CityScene Media Group. Feedback is welcome at feedback@cityscenemediagroup.com.
