May 2010 MS Hot Updates!

Gilenia (FTY720, fingolimod) heads to a FDA Advisory Committee June 10 for review.   Gilenia may become the first oral treatment for MS.  Gilenia is a 0.5 mg capsule taken daily.  Gilenia blocks certain immune cells from leaving lymph nodes, preventing attack on the brain and spinal cord.   In the FREEDOMS trial, Gilenia reduced new relapses by 54%, reduced the likelihood of disability progression by 30% and reduced active contrast MRI lesions 82%.  Risks include slowing heart rate with the first day of treatment, swelling in back of eye (macular edema), mild blood pressure elevation, liver blood test abnormalities and potential serious infection.

Ampyra is FDA-approved to help walking in people with MS.   Improvement was seen in 35-43% of patients in trials.  Four out of 229 patients did have seizures during the extension phase of one trial after the main part of the trial ended.  A big concern is driving restrictions which vary state by state if you have a seizure.

Failed treatments recently studied in MS:   Aricept (Donepezil) for thinking and memory,  Lipitor for first attack of MS, and Omega 3 Fatty Acids (Fish Oil) for depression in MS.

CCSVI Update:   Dr. Zamboni reported at the American Academy of Neurology Meeting in Toronto that 90% of MS patients and none of 45 non-MS patients had vein blockages.  Interestingly,  these percentages were very different from Dr. Zivadinov’s announcement of 56% of MS patients and 22% of healthy control patients had vein blockages.  An independent, multi-center study is necessary to confirm whether vein blockage is indeed more common in MS.  A study of 16 MS patients (all happen to have CCSVI) showed increased iron deposits in parts of the deep brain (thalamus and hippocampus) on MRI.  However, these parts of the brain are not typically involved in MS.  Iron can be found in clean-up cells called microglia and in cells that make myelin called oligo’s.  Therefore, iron from red blood cells into the brain from vein occlusion seems hard to prove based on this observation alone.  Reduced blood flow in the brain and decreased cerebrospinal fluid flow rate were also reported in CCSVI, but no connection was made between the actual veins that were occluded to the side of the brain with decreased blood flow.