Experts believe that giving patients suspected of having multiple sclerosis but who have not yet been formally diagnosed with powerful drugs could save them a lifetime of debilitating symptoms.
Currently, the most powerful drug treatments that address the underlying causes of the neurological disease are reserved for those with more advanced cases.
But a growing body of research suggests that giving such drugs before symptoms worsen could keep the condition stable for a decade.
Now, in a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place.
Around 130,000 people in Britain have multiple sclerosis (MS). The disease causes the body’s immune system to attack nerve cells in the brain and spinal cord, which affects patients’ bodily sensations and gradually leads to mobility and vision problems, muscle spasms, bladder problems and fatigue There is no cure.
A growing body of research suggests that giving some types of medication before symptoms worsen could keep the condition stable for a decade (stock image)
There are several types, but the most common is what is known as relapse and remission, which affects about 80% of patients and causes symptoms to flare up sporadically, sometimes with years in between.
Most seek medical help first after experiencing a period of telltale symptoms, such as tingling and numbness in the arms and legs. But getting an accurate diagnosis is a challenge.
Doctors perform brain scans to look for early signs of nerve damage in the brain and a lumbar puncture to analyze cerebrospinal fluid for signs of MS-related damage.
Some patients will have several visible lesions: dark or light patches of scarring (sclerosis) in the central nervous system that look different from normal tissue, but others may develop them later.
For one in five suspected patients, the lesions do not develop at all and their diagnosis is not indeed MS.
Doctors have therefore been reluctant to offer powerful drugs that change brain tissue in the early stages to patients without multiple injuries, in case it turns out to be unnecessary.
Patients in the new study will receive a low-risk drug called natalizumab before their diagnosis is confirmed, to see if those with little brain damage can benefit.
Professor Klaus Schmierer, a neurologist at Barts Health NHS Trust in London, plans to recruit 40 patients who have visited their GP or A&E unit with suspected MS. All will undergo MRI scans to check for at least one brain injury.
Twenty volunteers will receive a two-week course of natalizumab, which works by preventing immune system fighter cells from reaching the brain and spinal cord and attacking nerves.
The drug stays in the body for only eight weeks, while others can stay for 18 months, so if patients don’t have MS, they can come off it without risking long-term effects.
The other 20 patients will receive a placebo.
In a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place (stock image)
Experts say this reflects a treatment pattern similar to stroke, where it starts immediately, without waiting for a confirmed diagnosis. Scientists say the new field of research marks a “mindset shift” in understanding how the disease develops.
Previously, doctors believed that brain damage that accumulates after diagnosis indicates that the disease will progress.
Now, experts think the first signs of dead cells may also be crucial, and giving highly effective drugs early can stop the disease in its tracks.
“We have noticed that there are signs that indicate how the disease will progress from the beginning,” says Professor Schmierer.
“In the early stages, the brain can help reset the connections that MS might have damaged. So if we start treatment early instead of waiting, could it give patients a better chance of really long-term remission? Could represent a great change in the quality of life of patients”.
The new study follows a seminal paper showing the regime’s impact. An Australian paper published in The Lancet in April 2020 showed that patients who started taking the drugs within the first two years after diagnosis were less likely to see their disability worsen. After ten years, patients who took the drugs early barely saw their condition change.
Two women who understand the importance of early treatment are sisters Vikki Langford and Zoe Bowman, who were diagnosed with MS within weeks of each other in 2017.
While Vikki had access to powerful treatments within weeks, due to her brain injuries, Zoe, who has a less common type of MS that progresses very slowly, had to wait nine months.
Vikki, 56, from York, said: “Time is always of the essence. Although we don’t know what would have happened if Zoe had had earlier access to treatment, her symptoms got worse while she waited.”
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