Giving potent medications to patients suspected of having multiple sclerosis but who have not yet been formally diagnosed could save them a lifetime of debilitating symptoms, experts think.
At present, the most powerful drug treatments that address the underlying causes of the neurological disease are reserved for those with more advanced cases.
But a growing body of research suggests that giving these types of drugs before symptoms worsen can keep the condition stable for up to 10 years.
Now, in a world’s first trial, UK experts will examine whether treating patients as early as possible can prevent some from worsening.
About 130,000 people in Britain have multiple sclerosis (MS). The disease causes the body’s immune system to attack nerve cells in the brain and spinal cord, affecting the patient’s physical sensations and gradually leading to mobility and vision problems, muscle spasms, bladder problems, and fatigue. There is no medicine.
A growing body of research suggests that giving some types of drugs before symptoms worsen can keep the condition stable for up to 10 years (stock image)
There are several types, but the most common is what is known as relapsing and remitting, which affects about 80 percent of patients and causes symptoms to flare up sporadically, sometimes with years in between.
Most first seek medical attention after a period of telltale symptoms, such as tingling and numbness in the arms and legs. But getting an accurate diagnosis is challenging.
Doctors perform brain scans to look for early signs of nerve damage in the brain, and a lumbar puncture to analyze the 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.
In one in five suspected patients, the lesions do not develop at all and their diagnosis is in fact not MS.
Therefore, doctors have been reluctant to offer potent drugs that alter early-stage brain tissue to patients without several lesions, in case that proves unnecessary.
Patients in the new study will be given a low-risk drug called natalizumab before their diagnosis is confirmed, to see if it could benefit people with little brain damage.
Professor Klaus Schmierer, a neurologist at the Barts Health NHS Trust in London, plans to recruit 40 patients who have visited their GP or emergency room with suspected MS. All will undergo MRI scans to check for at least one brain lesion.
Twenty volunteers receive a two-week course of natalizumab, which works by stopping the immune system’s fighting cells from reaching the brain and spinal cord and attacking the nerves.
The drug only stays in the body for eight weeks — while others can stay for 18 months — so if patients don’t have MS, they can get rid of it without risking long-term effects.
The remaining 20 patients receive a placebo.
In a world’s first trial, UK experts will examine whether treating patients as early as possible can prevent some from worsening (stock image)
Experts say this reflects a similar treatment pattern to a stroke — where it starts right away, without waiting for a confirmed diagnosis. Scientists say the new area of research marks a “change of mindset” in understanding how the condition develops.
Previously, doctors believed that damage in the brain that builds up after diagnosis indicates that the disease will progress.
Experts now think the earliest signs of dead cells could also be crucial, and administering highly effective drugs early could stop the disease.
‘We have realized that there are signs that indicate how the disease will develop from the start,’ says Prof. Schmierer.
‘In early stages, the brain can help restart the connections that MS may have damaged. So if we start treatment early instead of waiting, could it give patients a better chance of truly long-term remission? It could mean a huge change in quality of life for patients.’
The new study follows a groundbreaking paper showing the impact of the regime. An Australian paper published in the Lancet in April 2020 found that patients who started taking the drugs within the first two years of diagnosis were less likely to see their disability worsen. After ten years, the 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 of each other in 2017.
Although Vikki had access to powerful treatments within weeks because of her brain injuries, Zoe, who has a less common form of MS that progresses very slowly, 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 had Zoe been given access to treatment earlier, her symptoms worsened while she waited.”