Multiple sclerosis, a drug could delay the onset of the disease

The drug is old, the promises are new, albeit to be taken with caution. The promise is this: we could delay the onset of multiple sclerosis, thanks to a drug administered early, even before the symptoms appear. This is the claim of a study that will be presented in the next few days at the American Academy of Neurology congress in Boston, which showed the ability of teriflunomide to prevent multiple sclerosis in a group of people with radiologically isolated syndrome, i.e. a condition in which central nervous system typical lesions of the disease are seen but the person has no symptoms.

Before the symptoms appear

Teriflunomide is a drug used for some time in the treatment of multiple sclerosis in the relapsing-remitting forms. It acts as an immunomodulator with anti-inflammatory activity, and helps regulate the runaway responses seen in the immune system of people affected by multiple sclerosis. But could it help prevent the symptoms of the disease before it even occurs?

In fact, the radiologically isolated syndrome, under certain aspects, can be considered one of the very early signs of the disease. But not always, as explained by Marco Salvetti, full professor of Neurology at the Sapienza University of Rome and Director of Neurology of the S. Andrea hospital-university hospital: “We speak of radiologically isolated syndrome when in magnetic resonance imaging, performed for other reasons, such as headaches, for example, there are lesions compatible with those found in multiple sclerosis”. In multiple sclerosis, these are manifestations of damage to the nervous system caused by the abnormal response of the immune system, which attacks the myelin, the coating that covers the axons of neurons. In radiologically isolated syndrome there are similar lesions, but without the weakness, visual disturbances, fatigue, numbness, pins and needles that characterize the initial stages of multiple sclerosis: “If it is true that in a good percentage of cases these people will develop multiple sclerosis within 5-10 years, some people may never develop the disease,” adds the neurologist.

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Different strategies for prevention

And it is here that one of the open challenges in the field can be perceived: “All the therapies or a good part of the therapies used against the disease are for life: should we treat patients who perhaps will never develop the disease anyway?”, continues Salvetti. In this dilemma – still open in the field – teriflunomide presents itself as a possible low-impact therapy with a view to preventing symptoms, as it does not cause marked immunosuppression of the immune system, the expert points out. In the study presented in Boston led by Christine Lebrun Frenay of the University Hospital of Nice (France), conducted on 89 patients, in those taking teriflunomide the risk of developing symptoms of multiple sclerosis was 72% lower than with placebo. “It is an encouraging result, albeit expected – continues Salvetti – and which falls within the vein of various similar researches in the field. In many quarters, in fact, people are trying to understand if it is possible to administer low-impact therapies to prevent the onset of symptoms”.

Thanks to an experiment funded by the Italian Multiple Sclerosis Foundation (FISM), Salvetti’s team is also participating with a study that tests the effectiveness of a vaccine, the one against tuberculosis, to prevent conversion from radiologically isolated syndrome to multiple sclerosis: “The idea is that this vaccine, safe and low-cost, could somehow help modulate the immune response, favoring a balance that promotes the response against foreign agents such as microbes rather than recognizing one’s own organs and tissues ”, continues the researcher: “Alongside the possibility of preventing the onset of symptoms, in the event of positive results, studies such as these could help us understand something more about the biological mechanisms of the disease”.

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The challenge: identifying patients

Even if today the possible field of action remains limited. Another of the challenges, as you can imagine, is to find people with radiologically isolated syndrome, since these are occasional findings. “We cannot imagine doing MRIs at all,” Salvetti points out. But not only. Considering that not all cases of radiologically isolated syndrome progress to multiple sclerosis: “It is important that medical professionals are cautious when using MRI to diagnose this condition, selecting only patients at risk of developing MS and not increasing misdiagnoses by MRI,” concluded Lebrun Frenay.