“Multiple sclerosis is a disease of civilization”

Doctor of Medical Sciences, Professor of the Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University. N. I. Pirogova, the 38th doctor in the family, Alexei Boyko followed in the footsteps of his father, neurologist Nikolai Boyko, who worked in Star City with the first cosmonaut corps. But went further.

Aleksey Boyko is a qualified neurologist who also studied immunology at the same time, he was at the forefront of research on drugs that change the course of multiple sclerosis, he was one of the first to talk about neuroimmunology, cognitive impairment in multiple sclerosis (hereinafter referred to as MS. – Approx. ed.) … He stood at the origins of the creation of the first in Russia, the center of MS, through which during its existence (until 2014) more than 6000 people passed annually. Aleksey Boyko is an example of a person who has found his life’s work. A matter of life that has changed the lives of hundreds of thousands of people around the world.

In articles, scientific papers, you always emphasize the novelty of the results obtained. Is it important for you to do something new?

Well, of course! New in medicine is a step towards better treatment of diseases. For example, we were the first to talk about childhood MS. We made our first publication on this topic in 1990. We have opened the first pediatric MS office in Russia at the Scientific and Practical Center for Child Neurology and Psychiatry. Our first work on neuroimmunology in MS was also published in 1990, and now this area is considered one of the most promising. In 1997, at one of the world congresses on neuroscience, I took the liberty of making some criticism of the report of Donald Party from Canada, then one of the leading experts in the field of MS in the world. He introduced MRI in the diagnosis of MS, organized an immunological laboratory for the study of MS, was the first author of the first effective treatment for MS (beta-interferon). That is, everything that was done in the field of MS at that time was his merit. And here I criticize his report. Instead of saying: “Guy, where are you going?” After the performance, he approached me and invited me to work in his clinic. I brought Russian data on childhood MS to Canada. Pati said he had never seen such data. We researched the issue together, and in 2002 in the American journal Neurology – it is very difficult to publish work there – we published a series of articles on childhood MS. With her in Canada, a program for children’s MS began, a network of centers was created. I spoke at the opening of this program at a conference in Toronto.

And before that, there were no cases of childhood MS at all?

There were isolated cases. Few have studied them systematically.

And what happened to the children?

They were given other diagnoses, such as acute disseminated encephalomyelitis. No one could even imagine that MS happens in children so often. There are about 500 children with this diagnosis in Moscow today. The sooner we recognize the disease, the more effective the treatment. Now not a single world and European congress on MS is held without the topic of childhood MS.

You have devoted more than 30 years of your life to work on MS. Tired of this topic?

How can you get tired when every year we learn something new, make discoveries. There is always something to learn, something to talk about. For example, there is primary progressive MS, which affects only 10% of patients. With this type, there are no exacerbations and periods of remission, the patient’s condition gradually worsens. A few years ago we could not treat this type with anything. But today we can. New and safer treatments are emerging.

I’m afraid to ask how much they cost…

Expensive. But they are. This is not only a problem of our country, the whole world notes that medicine is becoming more and more expensive. (The cost of first-line drugs, most often used in the treatment of relapsing-remitting MS, varies from 20-25 thousand rubles. – Note ed.). Patients in Russia can receive many medicines for free, for this you need to register. Another issue is the side effects. The more expensive the drug, the stronger it is, and, as a rule, it has a higher number of unwanted side effects that need to be controlled. Therefore, we now face the challenge of individualizing the treatment of MS.

MS is one disease, but there are many different subgroups within it. If we can identify not just, for example, relapsing MS, but look at the totality of factors, the somatic condition, we will be able to select drugs specifically for each of the subgroups. Somewhere you will need a strong medicine, somewhere not. Although among doctors there are supporters of another method – immediately attack with heavy drugs, and then support with soft drugs.

Patients often demand the strongest medicine and don’t care about side effects. “Give me something so that my legs don’t fail in the future.” If the doctor does not prescribe, they will go to a lawyer or another doctor who will prescribe. And it doesn’t matter that heavy drugs have a lot of side effects. But it is important to constantly weigh the expected benefits and risks, to implement a risk management plan for unwanted side effects.

“There are no curable diseases…”

Speaking of multiple sclerosis, you use the word “treatable”, but the disease is incurable…

And I do not know human diseases that are curable. “Cured, cured” is a cliche that people who are not entirely conscientious resort to. Did you pay attention to the life span of biblical heroes? 300-400 years! There is not a single person today who managed to live to such an age. Consider why. For example, is the flu curable? Everyone knows the joke, which is not a joke at all: “If the flu is treated, it will pass in 7 days, and if not, in a week.” Is the flu cured? Nothing like this.

They cut out the appendix, but did not cure it. The risk of developing bowel cancer in operated patients varies. You can’t say it’s cured. We can say that this pathological process no longer bothers a person.

We have patients who receive a certain drug that changes the course of MS for 15 years, during which time they either do not have exacerbations or they are very rare. But this is not a “cure”. The disease is coming, mild, but going. A certain neurodegenerative process that we cannot yet cope with. The goal of MS treatment is to make sure that the disease does not interfere with life. Caries is an incurable disease, and what are you doing to fight it? Brush your teeth. What a horror, what a nightmare! You have to brush your teeth every morning…

Yes, only the brush and toothpaste are a bit cheaper and have no side effects…

One of the drugs in this group in 2016 was recognized as absolutely safe, it can be used even during pregnancy. Brush your teeth, inject at the same time, and run to work. normal social life.

And without treatment, have there been cases in your practice when there were no exacerbations for 15 years?

Everyone talks about the so-called benign MS. We even had a Ph.D. thesis on this topic at the department. It was possible for years to follow 50 patients who had this “benign” MS: a minimum number of exacerbations and a minimum increase in disability at the onset of the disease. To our great regret, over the years of follow-up, almost 80% ceased to be benign and progressed to the usual or aggressive stages of MS. And it is impossible to predict when this change may occur. Therefore, today the tactic all over the world is this: we found out, we start treatment. We have no right to take risks.

“… but we will live”

You call MS a “disease of civilization”. Why?

In recent decades, outbreaks of MS have been recorded even in those countries where MS has never been ill. For example, 50 years ago, in a textbook on nervous diseases prepared by Uzbek neurologists, it was written that Uzbeks do not get MS. Today in Uzbekistan there are over 20 cases per 100 population. Arab countries: Kuwait, Iran, Saudi Arabia, Bahrain, Qatar – in the last few years there has been a sharp surge in the incidence of MS. They even overtook us in terms of the number of patients: in Russia – 50 cases per 100, they have up to 000. Why now?

First, the time has come when alien DNA material has accumulated and we are seeing the consequences. There are a number of viruses that are embedded in the genetic material and can be inherited. This is not only genetics from mom and dad, but also those fragments of viruses that are integrated into the genome throughout life. “Genetic garbage” and leads to the fact that right now there are so many autoimmune and oncological diseases. In MS, one of the important viruses is the Epstein-Barr virus, and retroviruses are also potentially involved. They contribute to various mutations, for example, a frameshift (a sequence of nucleotides in DNA or RNA that is potentially capable of encoding a protein. – Approx. ed.). And this violates the control of immunity “friend or foe.”

Secondly, external factors in the development of civilization. In the early 90s, the incidence of MS suddenly increased 15-fold in western Norway. It turned out that the reason was a change in diet from fish to meat. In the 70-80s, a lot of meat began to be imported to Norway from Sweden and Italy. Meat products, especially sausages and smoked meats, are strong immunostimulants. Weak factor? Weak! But when it acts for decades, it affects human health.

Sardinia, quiet Italian island. Suddenly, in the 70s, an outbreak: more than 100 cases per 100 population – one of the highest rates in Europe. Conducted an analysis, which became the determining factor. It turned out that one of the important factors is the appearance of several oil refineries in the center of the island, that is, environmental characteristics.

Are you saying that everyone will get sick in the end?

The longer we live, the more civilizational factors influence us. This is neither bad nor good. This is a given. In the USA, Canada, Germany, when an elderly person dies, the cause is indicated as “aging”, that is, he died of old age. I think it’s fair. We always make some kind of diagnosis, a heart disease, a vascular disease of the brain, for example. Maybe it’s easier to understand why a person died. I’m in favor of a more rational approach. The task of doctors and medicine in general is to make sure that a person spends the allotted years of his life in comfort, so that diseases do not interfere with his life.

Sounds cynical…

Maybe. But the purpose of my words is to explain that MS is no longer as scary as it used to be. You don’t die from MS. Previously, people died from diseases parallel to MS, more often infectious complications, because patients without treatment very quickly became bedridden. Now the situation has changed. Seven years ago, I spoke at a conference in Norway on the genetics of MS. Huge hall, more than a thousand patients. There were wheelchair users in the front rows, yes. But, sorry, these are older people. The average age of patients in the hall is 63 years. What I want to convey to people, today MS is not a sentence. And one more disease, the course of which we can control, which means that we can provide patients with many years of a full life.