A New Drug for Multiple Sclerosis
Jun 10, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
May has just come and gone again. May is a magical month. It is the birth month of The Buddah, Bob Dylan and yours truly. May was the 60th Anniversary of Sir Edmund Hillary and Tenzing Norgay becoming the first men to reach the 29,028ft (8,848m) summit of Mount Everest. I remember reading a book about Mount Everest on a plane called Into Thin Air. The pilot came on the intercom and announced our cruising altitude of 30,000 feet. That meant my plane was flying at the same height as Everest! It is not possible to climb Everest most of the year. For most of the year, the jet stream winds pound the mountain with 100 to 200 mile per hour winds. But, May is special. Usually in May, the Jet Stream shifts away from the mountain. So, in May there are between 4 and 15 days that it is possible to climb to the top of Everest. This is called the Summit Window. Summiting Everest is not for the faint of heart. Hundreds of people have died in the attempt. Often their bodies are left on the mountain and serve as grim reminders of how perilous the journey to the top of the world is. Despite the difficulty and danger, many people follow the footsteps of Hillary and Norgay and challenge Everest every May.
May is also Multiple Sclerosis awareness month. What is MS or multiple sclerosis? It is an unpredictable and often debilitating disease of the brain and spinal cord. Some of the long nerves in the brain and spinal cord have a covering called myelin. Myelin works a like the plastic covering around a telephone cord. Without the insulating plastic cover, some of the signal that goes down the telephone wire would leak out. The voice on the phone would sound delayed, weakened, garbled or possibly not there at all. In MS, the body mistakenly attacks the insulating myelin sheath around some of the nerve fibers. So the signals from the brain to the body or body back to the brain get weaker, delayed, garbled or go missing altogether.
Since MS affects some myelin covers some of the time, this leads to one of the most fascinating and frustrating facets of the disease. The symptoms of MS change and are unpredictable. The most common form of MS, relapsing and remitting MS, has well defined attacks followed by complete or partial recovery. It can go away and come back. And it can affect vision, hearing, memory, balance and mobility. And this is not just that the disease affects different people in different ways! The same person can have different symptoms each attack. You can imagine how frustrating it would be to both worker and employer if a worker came to work one week in a wheel chair and then the next week could walk. Then six months later she could still walk, but says she cant read her computer screen without magnification. And then she is fine. And then six months later she calls in sick for 3 weeks because she is too fatigued to leave the house. Unfortunately, since people with MS often dont look sick and they have symptoms that come and go, some confused employers treat employees with MS unfairly.
Compared with big diseases like heart disease, cancer and diabetes, why should you care about MS? While it is true that MS isnt as common or as deadly as heart disease, cancer and diabetes, MS is the most common neurological disease affecting young adults in Canada. In fact, Canada has one of the highest rates of MS in the world. Within our country, Manitoba has one of the highest rates of MS in Canada. Dr. Ruth Ann Marrie, who works at the MS Clinic in Winnipeg, published a paper about MS prevalence in Manitoba in the January 2010 issue of Neurology. She concluded Manitoba has one of the highest prevalence rates of MS in the world. So, Multiple Sclerosis does affect a lot of people in our area. There are even more local connections to MS research. Dr. Mike Namaka, who grew up in Winnipegosis, is also an MS researcher at the Winnipeg MS Clinic. Its nice to see a Parkland prodigy work on a Manitoba problem.
On April 9, 2013 Biogen got approval for a new drug for MS. It is called Tecfidera and its generic name is dimethyl fumarate. I was fascinated when I heard it was such a relatively simple molecule. Most of the new MS drugs are complicated proteins like interferon or modified antibodies. The researchers dont know exactly how dimethyl fumarate works in MS. They think it may help protect cells from oxidative stress. It has been used in Europe for years to treat psoriasis. Dimethyl fumarate is the second oral drug for relapsing remitting MS. It seems to work as well as fingolimod, the other oral drug for MS but with less side effects. It does have side effects, though. It can cause stomach problems like nausea and flushing. If you take dimethyl fumarate with food, that reduces the chances of flushing and the stomach problems. Some have suggested that if you take a regular, non-coated aspirin 30 minutes before the dimethyl fumarate that can reduce the flushing as well. The flushing also just seems to get better the longer the patients are on the dimethyl fumarate. The really big downside to the dimethyl fumarate is its cost. It costs over $2000 per month and being a new drug, Manitoba Health will not cover it yet.
Summiting Mount Everest is an impressive feat that inspires us. Ending MS is like summiting Everest. The journey will be difficult and long but as Sir Edmund Hillary and Tenzing Norgay showed the world 60 years ago, it is possible. The magical month of May has come and gone. But maybe with dimethyl fumurate and other treatments we are getting closer to ending MS. That is a Summit Window we can all hope for.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
MS Society of Canada www.mssociety.ca
Tecfidera FAQ page: mssociety.ca/en/treatments/treatments_tecfidera_faq.htm