A Kinda Sorta MS Bike Tour

Sep 15, 2020

By Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

On a warm September evening on the bridge over the Wilson River, I realized three important things: I needed my wife and my rescue dog; I'm the last person you want inflating your bike tire; and I miss the MS Bike Tour. I was on the Wilson River bridge with a couple of friends. I noticed the tire on one of their bikes was getting a little low. We tried to inflate it with my bike pump. Instead, we managed to tear a hole in the tube stem and release all the air from the tire. To pass the time as we were waiting for my wife and rescue dog to come get the newly disabled bike, I told a tire bursting story from 1992.

You know how many drugs we had to slow the progression of Multiple Sclerosis in 1992? Exactly none. 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. It can be hard to see progress in our busy day to day lives, or when you are puffing up that big hill towards the Hilton rest stop. But over time, we can see how the money raised in the 24 in person Riding Mountain Challenges, and the one virtual one in July 2020 has sponsored research that really has improved the lives of people with MS.

Back in 1992, I was a student working at the TRIUMF particle accelerator on the UBC campus in Vancouver. Yes, I've been a geek for a long time. I flew from Winnipeg to Vancouver with my sister's mountain bike. I don't remember Michelle being happy my parents told her she was lending it to me for the summer. As recommended, we deflated the tires for its flight in cargo. After I got settled into residence at UBC, I had to inflate them. I walked the bike to a gas station. I used their air hose and immediately exploded both tires. Over the next couple of days, I found a bike shop in the pre-smart phone and pre-widespread internet era. I walked the bike shop and bought some new tubes. I walked home and changed the tubes. Then walked the bike to the gas station and immediately exploded the tires again. During the next iteration of bike shop and gas station, I inflated more carefully and was successful. You might wonder why a physics research facility like TRIUMF would hire someone who was such a slow learner. I don't know the answer to that either.

Back to the near present, MS 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.

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 progressive 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 in early 2020 Health Canada has now approved its use as well.

You may be thinking that it is great that 25 MS Bike tours have raised money for research. It is great that 25 years of research has developed treatments for MS. But 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.

Doris pulled up to us on the Wilson River bridge. Sheldon the rescue dog wagged his tail so hard his whole body wiggled. We loaded the bike with the flattened tire into the truck. The two of us left with functional bikes rode home. It still was a nice warm evening to cycle with friends. But I miss the MS Bike Tour in September. I can't wait for the in-person ride to come back and to see all those cyclists back in Dauphin. I can't wait to see what research and MS treatments Bike Tour fund raising will contribute to over the next 25 years. But during the 2021 MS Bike Tour, if you have a flat, maybe wave me on if I ask if I can help.

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/article/health-canada-approves-siponimod-for-treatment-in-adults-with-active-secondary-progressive-ms#:~:text=Health%20Canada%20has%20approved%20Mayzent,the%20progression%20of%20physical%20disability


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