Multiple sclerosis is incurable, but there are drugs that slow the progression of the disease in some patients. Whether or not a person will respond to a given treatment depends on the form of MS and the progression of the disability so far.
MS (sclerosis multiplex) is an autoimmune disease. Scientists can accurately describe the course of the improper reaction of the immune system, which in addition to pathogens also destroys the body’s own tissues (in MS – the protein envelope of nerves, i.e. myelin). Until now, unfortunately, no one has been able to answer, which makes the immune system malfunctioning and hyperactive in some people. Since the cause of the poor immune system reaction is unknown, it cannot be eliminated and thus completely cured patients with multiple sclerosis and other autoimmune diseases. Currently, medicine is only able to interfere in various phases of the disease process, i.e. modify the improper reaction of the immune system, e.g., it is better to block the blood-brain barrier so as not to allow damage to the myelin or to make the damage as low as possible.
Treatment for each person with MS should be individualized. The choice of drug depends on the form of multiple sclerosis and the duration, activity of the disease. The most common types of MS are:
– relapsing-remitting form – it is the most common form of the disease, it occurs in approx. 85-90% patients. Characteristic for it is the occurrence of exacerbations, the so-called relapses and periods of stabilization lasting several months and sometimes even years.
The initial course of the relapsing-remitting syndrome is considered to be the clinically isolated syndrome (CIS). Symptoms of demyelination appear in CIS, but the diagnostic criteria for MS are not met. Some researchers consider CIS to be preclinical cases of MS. There is a tendency in world medicine to administer immunomodulatory drugs in the CIS phase, which reduces the likelihood of developing clinical MS.
Immunomodulating treatment is most effective in people with a relapsing-remitting form who have a relatively short illness, are walking on their own or with little help. Currently, they are used in immunomodulatory therapy in the form of relapsing-remitting NSP. preparations:
Interferon ß 1a i Interferon ß1b – registered in Poland, administered in the form of subcutaneous or intramuscular injections (depending on the preparation), it is possible to obtain reimbursement of treatment costs by the National Health Fund for a maximum of 3 years under strict eligibility criteria.
Glatiramer acetate – registered in Poland, administered daily in the form of subcutaneous injections, currently, it is possible to obtain reimbursement of the cost of treatment for a maximum of 3 years, provided that strict eligibility criteria are met, if the treatment with ß interferons turned out to be ineffective (the so-called second-line drug). Recommended especially when it appears
natalizumab – registered in Poland, administered most often when the patient does not respond to the aforementioned preparations, administered outpatiently every 4 weeks in the form of intravenous infusions, currently not reimbursed in Poland
fingolimod – approved by the FDA (Food and Drug Administration) in the United States, pending European registration. Served in tablets.
In the case of relapsing-remitting, both immunomodulating treatment and treatment of relapses are important. A relapse is the worsening of existing symptoms or the appearance of new ones for at least 24 hours. In this case, most often in hospitals, immunosuppressants (corticosteroids) are administered in the form of intravenous infusions. It is very important to take calcium during immunosuppressive treatment (there is a possibility of the appearance of steroid-related osteoporosis) and to take protective preparations that protect the stomach.
– secondary progressive form – in about 80 percent people with MS, after several years of the disease, relapses stop appearing, the disability grows slowly, gradually, without sudden changes. A person with MS perceives the progress of the disease by comparing their functioning to what they were like a few years earlier.
Typically, treatment is limited to relieving symptoms. Sometimes, in the aggressive form of the disease, cytostatics are used, i.e. immunosuppressants, also used in anti-cancer treatment, such as e.g. azathioprine, mitoxantrone. From the group of interferons, Interferon ß1b has indications for use in this form of MS. In Poland, however, it is not possible to reimburse this preparation under the NHF therapeutic program in the form of secondary progressive MS.
– primary progressive form – a relatively rare type of MS, it occurs in about 10% of sick. After the first symptoms, there is no remission, the deterioration of functioning progresses without obvious relapses, gradually leading to disability.
– progressive-projective form.- the rarest form of multiple sclerosis. There is no remission, and the disease progresses slowly between relapses.
In both of the above embodiments, treatment is limited to the relief of symptoms and the possibility of administering cytostatics.
Text: Iza Czarnecka