The history of multiple sclerosis (MS) treatment

Biogen-08843 april 2021


A story of constant improvements
MS affects many people. Not only those suffering from the disease, but relatives, friends and the society as a whole are affected. Often, we focus on the negative aspects of the disease. We easily forget all the amazing advances made in MS research and nursing. When we summarize all the progress that has been made in the MS field, and perhaps especially in the past 20 years, it is easy to get a more optimistic view of the future.

Read the hopeful story of MS treatment here.

Early development
A disease suggestive of MS was described several hundred years ago. But it was not until late in the 19th century that it became a well-defined disease. Already at that time doctors wondered why the disease occurred and how to cure it.

Although we still do not know what causes MS, we do know a lot more about the disease today. One major achievement in the early 20th century was the suggestion that MS is caused by an autoimmunity that gradually destroys the myelin of the nerve fibers. This hypothesis grew stronger and stronger with increasing knowledge of our immune system.

This was a turning point in our understanding of the disease and from that point researchers started creating experimental models, both to study the development of the disease and its possible treatment and cure.

Research takes off during the 70s
It was not until 1969 that the first controlled clinical study on MS-patients was completed. This study showed that steroids could reduce the inflammation of an MS relapse. Although this was a major advance for research and the first step on the path towards modern treatments, steroids did not slow down disease progression.(1)

In the 1970s new imaging methods were developed and from the beginning of the 1980s, MRI began to be utilized to visualize the effect of MS on the patients’ brain in vivo. This new technology revolutionized both diagnosis and treatment of MS.

All these research advances  laid the foundation for the fast development of new therapies that has taken place since the early 90s. With new therapies, treatment was actually able to reduce the number and severity of MS relapses in patients with relapsing-remitting MS. The new treatments  had a positive effect on disease progression, and therefore we call them disease-modifying treatments. Over the last 25 years researchers have developed more than a dozen treatments that suppress relapses and alter the course of the disease.

Disease-modifying treatment revolutionises the treatment
The first disease-modifying treatment, interferon beta-1b, was introduced in 1993. It was an injectable medication and it has over the years been followed by several other injectable therapies. They all have made a difference to MS patients by slowing the disease activity.

In the beginning of the new millennium, more effective treatments started to emerge. In 2006, the first infused therapy, natalizumab, was approved for treatment of MS patients with insufficient clinical response to earlier treatment.

A few years later the first oral MS medications fingolimod, teriflunomide and dimethyl fumarate were approved to benefit the patients who could not tolerate medications that needed to be injected.

In recent years, we have gained access to even more treatment options for people with MS, such as alemtuzumab and cladribine. And recently, ocrelizumab and siponimod.

Great improvements over the last 20 years
Together with improved management of the symptoms of MS and comorbidities (e.g. bladder and sexual dysfunction, fatigue, pain and spasticity), the increased effect of disease-modifying treatments has changed the situation for many people living with MS. Faster diagnosis and earlier initiation of treatment have also contributed to the positive effects seen on disease development.

We know for instance that people with MS live longer lives today. Over the last 60­–70 years the standardized risk of dying among MS patients in countries like Denmark and Sweden has decreased significantly, and particularly during the last 20 years.(2)

Adapted from: Lunde HMB et al J Neurosurg Psychiatry 2017;88:621–625

Also, today fewer patients are disabled as a consequence of their disease. The probability of reaching EDSS 6 (Expanded Disability Status Scale), the cut-off limit for more severe disability before 50 years of age, has decreased significantly during the last 2 decades.(3)

It is also interesting to note that the overall cost of MS (in a country like Sweden) has  declined between 2006 and 2012. The reduced cost is mainly attributable to lower indirect costs of the disease, like reduced number of sick leave and disability pension days, ultimately implying that MS-individuals are living more healthy, active and functional lives today than just some 5–10 years ago.(4)

Adapted from: Gyllensten H et al

Over the last 20 years, the development in the field of MS has been substantial, and progress is continuously ongoing. So, although we still cannot cure the disease today, there is every reason to be optimistic about the future.

Biogen-08849 Mars 2021
Senast uppdaterad: 2021-04-22

Referenser:
1. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Timeline-of-Research.pdf
2. Lunde HMB, Assmus J, Myhr KM et al. J Neurosurg Psychiatry 2017;88:621–625
3. Capra R, Cordioli C, Rasia S et al. Mult Scler 2017;23(13):1757–1761
4. Gyllensten H, Wiberg M, Alexandersson K et al. Mult Scler 2018;24(4):520–528

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