Therapies Under Investigation
Scientists continue their extensive efforts to create new and better therapies for MS. There are a number of treatments under investigation that may curtail attacks or improve function. Some of these treatments involve the combination of drugs that are already in use for multiple sclerosis, such as the joint administration of mitoxantrone and glatiramer acetate (Copaxone).
However most treatments already in clinical trials involve drugs that are used in other diseases. These are the cases of alemtuzumab (Campath), daclizumab (Zenapax), inosine, or BG00012. Alemtuzumab performed better than interferon beta-1a in relapsing-remitting MS reducing disability, imaging abnormalities and frequence of relapses, at the cost of increased autoimmunity problems. These included three cases of thrombocytopenic purpura which led to the suspension of the therapy. Other drugs in clinical trials have been designed specifically for MS, such as fingolimod, laquinimod, or Neurovax.
In humans, BCG vaccine, the common, live, attenuated vaccine against tuberculosis, has substantially reduced recurrence of symptoms in multiple sclerosis patients. The frequency of new enhancing lesions as detected by Gd-enhanced MRI was reduced by more than half in 12 patients, comparing the six-month run-in phase to the six-month post BCG phase of the experiment. Persistence at subsequent MR scan was reduced from 18 to 1 lesion, and evolution to black holes was reduced from 28 to 6 lesions. The conventional explanation of such protection is that parasites (including bacteria) modulate the sensitivity of the immune system. BCG appears safe as a treatment for multiple sclerosis.
Many anecdotes are found on the Internet about the effectiveness of low dose naltrexone for MS, but no published scientific studies or case reports address its effectiveness. Statins administered in combination with interferons have not shown an improved efficacy over interferons only. Finally, there are also many early-stage investigations that in the future may emerge as new treatments. Examples of these are the studies trying to understand the influence of Chlamydophila pneumoniae or vitamin D in the origin of the disease, or preliminary investigations on the use of helminthic therapy, or angioplasty and venous stents based on the theory that an incorrect blood drainage system weakens the blood–brain barrier. Parenchymal stem cells have a great potential as a therapy since they could theoretically help to modulate the immune system to stop axonal damage and even repair the central nervous system. Nevertheless such therapies are still at the initial stages of research.
The Percutaneous Transluminal Angioplasty (PTA) that was proposed by Paolo Zamboni in 2009 as a treatment for chronic cerebrospinal venous insufficiency (CCSVI), is a controversial condition characterized anomalies of cerebrospinal veins that interfere with venous drainage from the brain. However, there is limited data supporting these endovascular interventions for CCSVI also known as “liberation procedures” because researchers are not able to reproduce Zamboni's results. The first report from Zamboni was an open-label study of 65 patients with MS who met criteria for CCSVI where they found that PTA was associated with significant improvement in some MS outcome measures, particularly for 35 patients with relapsing-remitting MS. A subsequent study of 31 patients with MS and CCSVI reported that treatment with balloon dilatation of extracranial veins was associated with improvement in fatigue scores. Criticisms of Zamboni's approach include the lack of control groups, the small number of patients, the study was not blinded and the results observed could be due to the placebo effect as all of the patients who were treated were previously on disease-modifying treatments. Several complications have occurred due to the lack of follow-up of treatments including deaths due to the migration of stents into the right ventricle and deaths due to brain haemorrhage while on anticoagulant warfarin. Currently, a $6 million study led by Dr Anthony Traboulsee is being conducted in Vancouver and Montreal where a total of 100 MS patients is randomly selected to have either the venoplasty or the placebo venoplasty and after one year the groups will be switched so everyone will receive treatment and be assessed without the patients' knowledge to eliminate the placebo effect and bias.
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