Cat: Are there any current or new treatments involved in brain development, in brain health, that we should be looking at?
Professor Gavin Giovannoni, Neurologist: Are there new treatments regarding brain health? Yes, I think there are. I mean there are two components to brain health in people with MS. There’s obviously the processes that are specific to MS, so these are the things that cause, slow down the progression of the disease. And so there’s two components there; there’s the so-called anti-inflammatory drugs, that switches off the MRI lesions and the relapses. And we’ve got a whole range of these; we’ve got over ten of these therapies now and in the next year or two there’s going to be another two more coming out. One of them is a drug called Dacluzumab, that’s given under the skin every four weeks, and the other one is called Ocrelizumab and this is given as an infusion every six months, continuously. And both those drugs will fall into what I would call a high efficacy bracket, they’re much more potent in terms of switching off inflammation.
And we’re now beginning to realise inflammation is what drives the progression of the disease and makes the brain unhealthy. So the whole concept is to try and shift our treatments to as early as possible when the brain is very healthy and keep it like that and try and get rid of all the inflammation. Then in addition to that we are testing drugs on top of anti-inflammatories.
What you’ve got to understand is if there’s a lot of damage that’s already occurred, a lot of the nerve fibres are primed to die off in the future, simply because they’ve been damaged and they are functioning, but they’re not functioning normally, so they’re overworking themselves and they die off prematurely. And so what we’re looking at now is can we add anything on top of the anti-inflammatories, we call that neuroprotection, stemming from can we protect the neurons. And so we are testing now in a whole lot of what we call early phase trials add-on neuroprotective drugs. And hopefully the next phase of MS drug development will be combinations of anti-inflammatory with a neuroprotection.
And similarly, another way of protecting damaged nerve fibres is to remyelinate them if they’re demyelinated and there are some early stage trials now looking at drugs that promote remyelination. We think that those damaged nerve fibres that remain demyelinated are primed to die off in future. So if we can promote remyelination we can protect them, so that’s another strategy that’s being tested. So yes, we’ve got a whole lot of new anti-inflammatories coming and then behind those anti-inflammatories I’m predicting we’re going to have combination treatments where we will be adding on neuroprotection and remyelination treatment, so it’s all very exciting.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.