MS Bike Update

Sep 20, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"I believe children are the future. Teach them well, and let them lead the way…" No one needs to hear me sing a Whitney Houston song, but you get the sentiment. Another MS Riding Mountain Challenge has come and gone. Despite Dauphin losing its local MS Chapter, staff and board, the Dauphin volunteers still make our Bike Tour amazing. But it was the kids who impressed me most this year. There were the Shewfelt kids who left me in their dust on the hills. There was Aiden and Rowan who work after school at the Dauphin Clinic Pharmacy who cycled their butts off. From volunteering at Rest Stops to cycling, there were so many good kids at the Bike Tour that deserve kudos. All of them were working hard to make the lives of people with MS better.

Aiden brought his mom out cycle with him on his first Bike Tour. Then he proceeded to leave her, me and a bunch of us slightly longer in the tooth cyclists in his wake as he flew up the hills. This was the second Bike Tour for Rowan and her friend Jocelyn. Rowan is a champ at fund raising. She was the top money cyclist for the last two Bike Tours. Rowan's family is directly affected by MS. On Saturday night Rowan made everyone cry, but in a good way. At the banquet, she gave a beautiful speech about how MS is part of her family's life every day, not just on one weekend of the year.

Let's back up. 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. Remember when all phones were connected to the wall with a cord? Myelin works a like the plastic covering around the 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 immune system mistakenly attacks the insulating myelin sheath around some of the nerve fibers. That makes the signals from the brain to the body or body back to the brain get weaker, delayed, garbled or go missing altogether.

Multiple Sclerosis is the most common neurological disorder in young adults. Every day, three more people in Canada are diagnosed with MS. It is estimated that more than 100,000 Canadians have Multiple Sclerosis. Around 3500 people in Manitoba have MS. Women are more than three times as likely to develop MS as men. MS can cause loss of balance, impaired speech, extreme fatigue, double vision and paralysis.

Besides Rowan's wonderful speech, Dr. Michael Cossoy reminded all the cyclists why they were raising money. Dr. Cossoy has rode his bike from Dauphin to Clear Lake many times. He is also a neurologist at the MS Clinic in Winnipeg. Dr. Cossoy hi-lited just two of the MS treatments that money from the MS Society has helped to fund. A Canadian clinical trial led by researchers at the University of Calgary's Hotchkiss Brain institute looked at an antibiotic commonly used to treat acne called minocycline. They found that minocycline can slow the progression of relapsing-remitting MS in patients who have just experienced their first symptoms. Luanne Metz et al. enrolled 142 patients across 12 Canadian MS Clinics including the one in Winnipeg. These participants had experienced their first MS symptoms during the previous 6 months. Half the participants got minocycline 100mg twice a day and half got placebo. The research team wanted to know how many of these people with only one attack of MS, which is sometimes called clinically isolated syndrome, went on to develop full blown MS.

At 6 months 61% of the placebo group had developed full blown MS, while only 33.4% of the minocycline group had. By 24 months pretty much as many people in the minocycline group had full blown MS as in the placebo group. Now that might sound disappointing, but it really is in line with what our current MS immune suppressing drugs can do. They delay the onset of more severe symptoms. Minocycline seems to delay the onset of more severe symptoms by up to 2 years. It is inexpensive, a pill not an injection and something neurologists can start using today! Since minocycline is already approved for use in Canada, the MS doctors don't have to wait for any other Health Canada approval.

Another type of MS is called primary progressive MS. In primary progressive MS, the symptoms start and just get worse over time. There is no "getting better" phase. A couple years ago, we had no treatments for primary progressive MS. But thanks to researchers and fund raising, a study called Oratorio had 732 participants with primary progressive MS. One third of the participants got a placebo and two thirds got ocrelizumab. Compared to placebo the ocrelizumab reduced the risk participants would get worse at a timed 25 foot walk, reduced having their MRI measured lesion volume get worse and reduced the chance of having their brain volume go down as measured on MRI. How does ocrelizumab work? Ocrelizumab is an antibody to the protein CD20. CD20 is a protein on the immune cell called B cells. B cells are believed to be involved in the abnormal immune response in MS. Ocrelizumab binds to CD20, found on the surface of B cells, and causes cell death. The more ocrelizumab injected, the more the B cells are depleted and less damage to the myelin sheath around nerve cells.

During the Bike Tour, the volunteers put little motivational signs along the route for the cyclists. One sign said, "Canada leads the world in Maple Syrup, Hockey and Multiple Sclerosis." Canada has one of the highest rates of MS in the world. The Manitoba and Saskatchewan area have one of the highest rates of MS in Canada. Before the first MS Riding Mountain Challenge, we had very limited treatments available to treat MS. After over 20 years of Bike Tours, we have over 14 powerful immune suppressors for relapsing a remitting MS and at least one for primary progressive MS. Progress is slow but real. And with kids like the Shewfelts, and Aiden and Rowan picking up the torch, I'm sure one day we will beat MS. Take it away Whitney!

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

Minocycline and MS - https://mssociety.ca/resources/news/article/common-acne-medication-offers-new-treatment-for-multiple-sclerosis

NEJM article on Minocycline and MS Trial - http://www.nejm.org/doi/full/10.1056/NEJMoa1608889?query=featured_home&

Ocrelizumab and ORATORIO Study - https://mssociety.ca/research-news/treatments-in-development/ocrelizumab2

 


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