Multiple Sclerosis

Sep 27, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I met Antonia in a horse-riding arena. It was an unusual place to have dinner. The sand and gravel floor was packed flat. It was very clean and horse free. All the other diners were buzzing with excitement. Antonia stood out both for her smile that touched both ear lobes and for her tiara. Antonia was surrounded by her family. I'm sure she was convinced this banquet of several hundred was in honor of her seventh birthday. And why not? All the happy strangers around Antonia could definitely double in for her royal subjects. Marc Clement was her master of ceremonies and provided Antonia musical entertainment. But besides celebrating Antonia's birthday, her subjects were also celebrating being halfway done our bike tour from Dauphin to Clear Lake and back. We were celebrating having raised $165,000 of our $160,000 goal. We were celebrating being one step closer to Ending MS.

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.

Back to the importance of research and the fundraising the MS Society does. Before the Bike Tour, I was working in Winnipegosis with our newest pharmacist, Rachel Sime. Rachel told me how she really enjoyed the lectures about MS in pharmacy school. I wondered out loud why I couldn't remember any MS lectures in my pharmacy training. Rachel innocently asked if there were any MS treatments when I was in school. And she was mostly right. I graduated in 1997. Before 1993 there were zero disease modifying treatments (DMT) for MS on the market. Currently, there are 14 DMT's approved in Canada for MS to reduce MS relapses and to slow the progression of the disease. Over time we can see how the money raised in the 24 Riding Mountain Challenges has sponsored research that really has improved the lives of people with MS.

And the research continues. Only a few years ago, we had no treatments for primary progressive MS. In primary progressive MS, the symptoms start and just get worse over time. There is no "getting better" phase. 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 is injected, the more the B cells are depleted and less damage to the myelin sheath around nerve cells. Ocrelizumab is approved for very early stage primary progressive MS in Canada and hopefully more approvals are coming.

Siponimod goes into the central nervous system and binds to the S1P receptor. That stops immune cells called T cells and B cells from attacking the nerves of MS patients. Siponimod is used to treat patients with secondary progessive MS. Those are patients who used to get better and worse and better again, but now just get progressively worse. Siponimod is approved by the FDA in the USA, and Health Canada approval is pending.

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 24 years of Bike Tours, we have over 14 powerful immune suppressors for relapsing a remitting MS and a few for primary progressive MS. Progress is slow but real. Like Marc Clement's song it has been a Crooked Journey. However, maybe when Antonia pulls out her tiara for her 17th or 27th birthday she'll be able to say, "Remember when my birthday party Ended MS?"

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.

MS Society of Canada www.mssociety.ca

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

Siponimod - https://mssociety.ca/research-news/treatments-in-development/siponimod-spms

 


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