Will we ever see a cure for multiple sclerosis? That’s one of the most frequently asked questions — and topics of conversation — among people living with this disease. “I’m so tired of feeling this way every day,” said one member of MyMSTeam. “I wish MS had a cure.” Another commented, “Praying that a cure for this disability is found in my lifetime!”
Although researchers have more insights into possible causes of MS, we’re still a long way off from a cure, according to Dr. Aaron Boster. A board-certified neurologist and president of The Boster Center for Multiple Sclerosis in Columbus, Ohio, Dr. Boster also has a YouTube channel covering many aspects of treating and living with MS.
“It’s unlikely that we're going to find a cure in my lifetime,” Dr. Boster explained in an exclusive interview with MyMSTeam. “I’m not saying that to be Debbie Downer. It’s still largely uncharted territory.”
The good news: Scientists are honing in on ways to improve quality of life with MS, which affects approximately 1 million people in the U.S. More MS therapies are being developed than ever before, according to the National Multiple Sclerosis Society. The disease is also being diagnosed earlier, so disease-modifying treatments can begin sooner. And scientists are discovering possible risk factors that could eventually help prevent the disease.
Thanks to these advances, MS will eventually become a “boring” chronic disease, Dr. Boster predicted. Like diabetes, MS would be managed with diet, lifestyle modifications, and medications.
“We’re starting to get successful at making MS boring,” he said. “That’s a realistic goal for everyone with the condition.”
MS is thought to occur when the body’s immune system attacks the central nervous system (CNS), causing inflammation that damages the myelin sheath, a protective coating around nerves of the brain and spinal cord. This disrupts the signals those nerves send to other parts of the body, causing such common MS symptoms as difficulty walking, spasticity, muscle weakness, fatigue, and cognitive fog.
Health experts believe that stopping inflammation is the key to stopping the disease in its tracks. In his interview with MyMSTeam, Dr. Boster identified three treatment types under development that are important steps toward improved quality of life — and possibly a cure. These are disease-modifying therapies (DMTs), remyelination treatment, and neuroprotective therapies.
DMTs work by modifying immune system activity to slow the course of active MS. Although these drugs can’t cure MS, they’ve been highly effective at reducing the inflammation that causes nerve damage and slowing disease progression.
There are more than 15 DMTs approved by the U.S. Food and Drug Administration (FDA), which can be administered orally or by injection or infusion. In clinical trials, DMTs have been shown to help reduce the frequency and severity of flare-ups. They can also reduce the development of new lesions and slow disability.
DMTs are prescribed primarily for people with relapsing forms of MS, which include relapsing-remitting MS (RRMS), clinically isolated syndrome (CIS), and active secondary-progressive MS (SPMS). They include drugs in several different classes that work in different ways.
Here are some classes of DMTs along with examples:
In addition to treating relapsing MS, Ocrevus was the first and is currently the only DMT indicated by FDA to treat primary progressive MS (PPMS).
Although DMTs are the best defense against MS to date, each person responds differently to the medications, and the drugs can have significant side effects. Your neurologist can recommend the best treatment options for your type and stage of MS. In partnership with your neurologist, you’ll make decisions about when to start, stop, or switch medications.
Although DMTs can reduce inflammation that damages nerves, they can’t stop or repair damage that has already occurred. Remyelination treatment, on the other hand, has potential to transform MS from a disabling disorder to a manageable one.
“We’re probably a few years out from having remyelinating agents available. That’s a short period of time,” said Dr. Boster, who shared that he has taken part in several “really exciting” trials.
According to one group of researchers, treatments aimed at remyelination are likely to become available within the next decade. Scientists are currently studying ways to stimulate the brain’s natural ability to repair damaged nerves in a person with MS.
A few of the compounds currently being studied for remyelination include:
Results from these and other clinical studies will hopefully make it clear which remyelination strategies are most likely to be safe and effective for people with MS.
Researchers are also investigating therapies that could slow brain atrophy, one of the most destructive actions of progressive MS and a reliable predictor of future physical and cognitive disability.
“We know that people impacted by MS have accelerated shrinkage of the brain and lose their functional reserve,” said Dr. Boster. “We need something to protect against that, but unfortunately [a neuroprotective agent] doesn’t exist yet.”
A few examples of medications being studied for their potential neuroprotective abilities include:
If studies can show that one or more drugs can safely prevent the worsening of brain atrophy in MS, new treatments focused on neuroprotection may be forthcoming.
Until a cure is discovered, Dr. Boster says the best defense against MS is fourfold. He recommends the following strategies for improving your quality of life with MS.
Deciding on an MS treatment requires a careful discussion with your neurologist to determine which medication is right for you. “I want [my patients] to take the most effective DMT they’re comfortable with,” Dr. Boster explained. “I also want to make sure it’s working for them.”
Aside from promoting good health in general, physical activity can help manage many MS symptoms. “Exercise should be part of your lifestyle,” Dr. Boster said.
Diet and vitamin D are essential to good MS defense, according to Dr. Boster. Low levels of vitamin D are common in people with MS. You can ask your doctor to check your vitamin D levels with a blood test. If you have low levels of the vitamin, Dr. Boster recommends discussing supplementation with your physician.
Diet is another important MS defense. A nutritious, well-balanced diet has the potential to reduce symptoms and improve quality of life. The National Multiple Sclerosis Society recommends the following:
Try these ideas for healthy snacks and quick bites.
Smoking has been shown to promote disease activity and to increase the severity of symptoms, cognitive impairment, and disability. It may also inhibit the benefits of DMTs. It’s very important to avoid tobacco, Dr. Boster warned.
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 196,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Do you follow news about MS research and the search for a cure? What works for you to manage your MS until a cure becomes available? Share with others in comments below or by starting a new conversation on MyMSTeam.