Coming Soon: Three New Oral MS Drugs

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With all of the ballyhoo going on about CCSVI, I think I've been guilty of ignoring some of the more "mainstream" news regarding MS research and drug development. As enticing as the CCSVI theory is, it's still far from proven, and until CCSVI theory might turn into CCSVI fact, the arsenal in the fight against MS will continue to be made up entirely of drugs designed to either modulate or suppress the immune system.

Two such drugs, Cladribene and Fingolimod, are nearing FDA approval. Both of these compounds are immunosuppressants, but what sets them apart from other current MS therapies is that they are meant to be taken orally, not by injection or infusion as is every other MS therapy currently available.

MS patients currently on the injectable drugs almost universally hate having to give themselves shots on a regular basis. I'm sure there are a few masochistic types out there who relish jabbing themselves with needles, but aside from the demented, the news of oral MS therapies has been met with great enthusiasm.

Cladribene and Fingolimod were both proven in clinical studies to be very effective at cutting down relapse rates and enhancing lesions in RRMS patients taking the drugs. Fingolimod also appears to hold the promise of slowing down disease progression as well, a goal which has long been a holy grail of MS research. The drugs were shown to be comparable in effectiveness to Tysabri, which is currently considered the most effective MS drug on the market. As with most things in life, though, with the good comes the bad. Unfortunately, both drugs carry with them the possibility of some very perilous side effects, most notably the increased risk of dangerous infections, and in the case of Fingolimod, an increase in the incidence of skin cancer.

Both of these drugs significantly suppress the human immune system, thereby inhibiting MS patients' immune systems from attacking their own cells and destroying nerve insulating myelin, thus causing the nervous system damage seen in MS. While drugs of this type have been shown to have proven benefit to MS patients, the long-term implications of suppressing the finely balanced and hugely complicated human immune system remain to be seen.

I don't mean to scare people off of using drugs that have demonstrable benefits, but I really wish that MS researchers would start concentrating their efforts on finding the root cause of MS, rather than figuring out new and nifty ways of suppressing an immune system gone awry, which is actually a symptom of MS, not the genesis of the disease. I've said it before and I'll say it again: treating MS by suppressing the immune system can be crudely compared to treating a broken leg with painkillers. Symptom relief is definite and measurable, but the underlying cause of those symptoms is left entirely unaddressed.

A third MS drug also on its way to a pharmacy near you is called Ampyra, which sounds to me more like a drug that should be used to treat the undead than MS patients. Who names these drugs, anyway? Ampyra is the first drug on the market designed to increase the mobility of MS patients, which I think we all can agree is a very good thing to do. Ampyra works by increasing the conductivity of damaged nerves, and was shown in trials to help 35% of those taking it increase by 25% the time it took them to walk 25 feet. Not exactly scintillating numbers, but as the saying goes, any port in a storm.

Ampyra is a slightly modified time released version of an older drug known as 4-AP, which has been available from compounding pharmacies for many years. I tried 4-AP a few years ago, and found its effects to be subtle but noticeable. As my disability increased, I found it to be less effective, so I stopped taking it. When Ampyra hits the market, maybe I'll give it another try.

An interesting fact about 4-AP (and thus Ampyra) is that the compound is used as an industrial bird poison, and is very effective at killing off large numbers of our feathered friends when they become pests. It does this by frying their little feathered nervous systems. When used in small doses in nerve damaged humans, though, those same nerve exciting properties help damaged nerves to work better. Just to be on the safe side, though, when I was on 4-AP, I made it a point to stop trying to fly. It's very important to strictly follow dosing instructions with this drug, as higher doses can lead to seizures.

Back when I was getting 4-AP from a compounding pharmacy, a month’s supply cost something around 30 bucks. The compound wasn't patented, so it was relatively cheap. Who wants to bet me that Ampyra, which is almost identical to 4-AP but has been patented and marketed by the drug company Acorda, will cost a teeny-weeny bit more than 30 bucks a month?