The future of multiple sclerosis patients? It reserves therapeutic innovations and also steps forward on the diagnosis. “We are witnessing a progressive refinement of diagnostic techniques. Diagnosis based above all on magnetic resonance imaging. There have been two important advances. One of these is the redefinition of criteria for making an even earlier diagnosis. And this also falls on therapies, because the earlier we make the diagnosis, the sooner we interrupt those mechanisms which then at a certain moment exceed the point of no return. The new diagnostic criteria, just to give an idea, have brought the latency period between the moment of clinical onset of the disease and diagnosis from an average of 13 months to 3 months. This gives us a further important intervention window because the same drugs used a little later have a reduced efficacy “. Speaking at Adnkronos Health is Massimo Filippi, director of the Neurology Unit, the Neurophysiology Service and the Neuro-rehabilitation Unit of the Irccs San Raffaele hospital in Milan.
The expert, who is full professor of Neurology and director of the School of Specialization in Neurology at the Vita-Salute San Raffaele University, also cites a second innovation on this front: “The international guidelines” which were published last year ” on how to best use magnetic resonance imaging in the various stages of the disease, to create a common language and better follow these patients with a set of minimum requirements and so that all centers act in the same way “. And then there are the advances on drugs, which continue. The scientist, who according to bibliometric research published in ‘Frontiers in Neurology’ is the most cited in the world in the field of multiple sclerosis research, refers to the “development of molecules capable of controlling or extinguishing the disease. We already have many available” , he observes.
“There are drugs with low efficacy, but more manageable and therefore associated with fewer collateral risks, and drugs with higher efficacy but more complex to use. The idea is to overcome the division between first and second line drugs and rely on the severity of the disease “to choose which ones to administer,” because we have several prognostic factors at the onset that tell us which patients can go worse and which better, and it is necessary to be able to choose the therapy in a more personalized way in those who have the most aggressive disease and who have less ” .
Recent news on oral drugs: “There is a drug, ponesimob, which is part of a class of drugs that sequester lymphocytes within the lymph nodes. Lymphocytes are the ones that trigger the immune cascade that then causes multiple sclerosis and, by not reaching the central nervous system, they are less likely to cause harm. This drug has higher receptor specificity and is potentially associated with fewer side effects. ”
The other “great advance – lists Filippi – was the arrival of another anti-CD20 drug, which is now entering the market and is called ofatumumab. It is administered monthly under the skin, it does not require infusion. So from a certain point of view. it is more manageable. On the horizon there are some drugs that are inhibitors of Bruton’s tyrosine kinase (Btk): they are still under study, in phase 3, they will arrive on the market in a couple of years but are very interesting, because they are oral and affect both the peripheral component of the disease and central inflammation. These drugs are low molecular weight and cross the blood brain barrier. They are therefore able to act on immune cells residing in the central nervous system and reduce those aspects of slow progressive damage. We await them with great interest because they touch a different immunological pathway “.
They are also developing “for anti-CD20 vectors that carry the drug directly into the brain. So we also have improvements in other drugs, such as natalizumab which is given by infusion and for which subcutaneous administration has been developed. There are two major chapters: refinement of what we already have and development of new molecules “. Another great aspect, concludes the full professor of Neurology, “is that both clinical and magnetic resonance measures have been developed more and more to study what is defined in English as ‘smoldering disease’, that is the most silent and invisible component of the disease but that progressively damaging the tissues exceeds a threshold and at a certain point develops a picture that is difficult to modify if you have not intervened before. There are acute events that are the tip of the iceberg but then there is an underwater part that is also much larger than one is gearing up to see “. It is this underlying disease that is “always best to recognize and treat first”.
THE DISEASE HAS CHANGED FACE – “Italy travels at the rate of about 3,400 new diagnoses of multiple sclerosis per year. And today we have about 130 thousand patients throughout the country. The average cost of the disease, between direct or indirect costs, is about 45 thousand euros per patient a year. So we are talking about about 6 billion a year, that is 0.28% of the national GDP – is the picture traced by Filippi – Multiple sclerosis is a chronic pathology, of the young adult, with a high management complexity, which requires a multidisciplinary team. It is the prototype of chronic progressive disease in medicine. Right from the start it presents progressive neurodegenerative phenomena which, if not caught on the spot, then in a more advanced stage of the disease translate into an important disability. This is therefore a problem both for an often young patient who is at risk of developing disabilities, but it is also a commitment for caregivers and for the national health service “.
However, a lot of road has been covered in recent years, emphasizes the professor in view of the next World Day dedicated to pathology (May 30). “A hope? I am of a certain age and have been dealing with multiple sclerosis since October 1984 and I can testify that we have gone from one to almost 20 effective drugs for the disease,” he says. “There is a common observation among colleagues who deal with the disease and it is that the disease has really changed its face. At one time it was inexorably progressive and disabling, but today it is possible to control it well for several years in the vast majority of patients. mine is that things continue with this step and, if the “progress” curve continues to grow in this way, if the disease is no longer scary now as it was 30 years ago, I believe that we can aim higher and higher. it is a world free from multiple sclerosis. It would not be bad – concludes the specialist – and it seems to me that the right path has been taken to reach it “.
#weapons #multiple #sclerosis #diagnosis #accelerates