always trivial, but not generally life threatening.
For example, depression (sometimes linked to
interferons) is treatable. Copaxone users may face
something called lipoatrophy, a scarring or hardening of fat tissues under the skin. Most of the time,
elevated liver enzymes (from the interferons) mean
rather little. Injection site infections—which can
be quite nasty—are treatable.
of the injection. And others who are hanging on,
waiting and waiting for a way to stop. No drug is
effective if people don’t take it.”
The worst aspect of all the standard drugs is
that they are only partially effective. For some
individuals they fail to work at all. “Copaxone is
moderately;good;for;almost;everyone,”;Dr.;Ran-
sohoff opined. “The interferons are quite effective
for some and almost ineffective for others and
we don’t know why. We urgently need a way to
determine who is a good candidate for interferon
and who is not. This is a highly biased opinion, of
course. My research team is working on it now.”
Risky, but producing results
Some of the new drugs appear to have advantages
in terms of markedly increased effectiveness in
both preventing new brain lesions from forming
and in controlling MS attacks. And because they
are taken by mouth or, like Tysabri, are delivered
as periodic infusions or injections—some only
once a year—they dramatically change the tolerability issues.
Tolerability is almost as big an issue as safety,
according to long-time MS clinician and clini-
cal researcher, Dr. Bruce Cohen, at the Compre-
hensive MS program at Chicago’s Northwestern
University. “I have patients who skip doses because
At the same time Dr. Cohen pointed out that
people have a very reasonable sense of caution,
because of the sheer newness. So do many health-
care professionals. Moreover Dr. Cohen comments,
“When someone doesn’t need therapy again for a
year, we’ll have to be sure they will really come in
for follow-ups in between so we can monitor for
possible side effects. In addition, the impact of
what we call ‘co-morbidity’—another condition,
like hypertension, asthma or diabetes along with
MS—could also be magnified,” he continued.
How it works: Inhibits activation and limits
proliferation of specific white blood cell populations—the T and B cells active in an MS attack.
When it is expected: Could be early 2013.
Alemtuzumab
•;Three;to;five;days;of;IV;pulses;once;a;year;for
people with relapsing MS
•;Effect;on;MS:;Inflammation;may;be;sup-
pressed for as long as five years; rates of attacks
and progression of disability appear signifi-
cantly lower than the interferons
•;Risks:;Up;to;30%;of;people;in;the;trials;have
developed serious but treatable thyroid dis-
orders and, far more rarely, a blood clotting
disorder;called;ITP,;which;can;be;fatal.;Also
rare, a possibility of bone marrow suppression
and increased cancer risk
•;Ongoing;monitoring:;tests;of;thyroid,;platelet
levels, kidney function, cancer screenings, and
routine lab tests
•;Pregnancy:;A;“wash-out”;period;of;at;least;one
year, followed by a normal white blood cell
count, is likely to be recommended for women
