Ask the Doctor

By Dr. Jack Burks
Vice President & Chief Medical Officer for MSAA

Q: What oral treatments are under investigation, how might they work, and how close are they to FDA approval?

A: Unfortunately, most MS treatments, if given orally, are digested and destroyed before getting into the bloodstream. Therefore, when seeking an alternative to injections, the search is on for a way to successfully deliver the drugs into the bloodstream unharmed. In addition to oral administration (by mouth), other options for taking medications include: sublingual (dissolved under the tongue), inter-nasal (sniffed up the nose), and inter-dermal (absorbed through the skin, often administered by a skin patch).

Researchers have looked into oral and other types of administration for the presently available, injected medications for MS. Oral Copaxone®, in pill form, was attempted several years ago, but the results were disappointing. With regards to the interferons (Avonex®, Betaseron®, and Rebif®), the interferon molecule appears to be too large for the different forms of administration aside from injection.

Nonetheless, other options are under onsideration. Some new oral treatments in experimental trials have potential. For example, FTY720 (Novartis Pharmaceuticals Corp.), which keeps lymphocytes from accumulating in the blood, has been reported to help MS in a small, one-year trial with MS patients. Other oral drugs for MS being studied include: AZD5904 (AstraZeneca), MBP8298 (BioMS), Oral Cladribrine (IVAX and Serono), temsirolimus (Wyeth Pharmaceuticals), and SB683698 (GlaxoSmithKline).

These investigative oral medications, should they prove to be effective, are at least three to five years from being submitted to the FDA for approval. My advice to those taking the currently available injections is to continue with them (according to your doctor's recommendations), so your MS will be in the best condition when oral drugs become available.

Q: I am 71 years old and have had MS for 34 years. My MS was stable until two years ago, when I was in a serious car accident and was badly hurt. Since that time, my MS has become much worse. I would like to ask if trauma like this can increase disease activity and cause symptoms to worsen.

A: Despite numerous anecdotal references, the most credible scientific studies have failed to prove a link between trauma and worsening MS. The American Academy of Neurology has written a practice parameter (position paper) stating the lack of scientific support for trauma causing worsening MS symptoms.

Regardless of the trauma, I am concerned about your increased problems and recommend you see your physician and possibly an MS expert in your area. The Consortium of Multiple Sclerosis Centers (CMSC) has medical facilities throughout the United States and Europe dedicated to serving individuals with MS. A directory of these centers may be found on their website by visiting www.mscare.org. You may also get contact information for the nearest center by contacting MSAA's Helpline at (800) 532-7667 and talking to a consultant. I am concerned that you may have an underlying infection or other problem that can be treated to improve your condition. I hope you are able to feel better soon.

Q: I am one of three sisters with varying stages of MS. Is there any genetic or other testing that would be of use to the MS community? We also have children and wanted to know if they can be tested for their risk of developing MS.

A: Prominent MS scientists are keenly interested in studying the genetics of MS.

I suspect they would welcome your participation in one of their genetic studies. While no one gene has been identified as "the MS gene," certain genes may play a role in the disease or even the response to certain drugs for MS. Let me suggest that you contact the laboratory of Dr. Stephen Hauser at the University of California at San Francisco, Department of Neurology, by calling the MS research coordinator's office at (866) MS-GENES, or (866) 674-3637. You may also find a good deal of information on their website at www.ucsf.edu/msdb. Unfortunately, reliable genetic or bio- markers of MS, with enough specificity to provide accurate estimates of risk for one's children developing MS, is not available. We only know that the risk is small; three or four percent on average.

Jack Burks, MD, is a neurologist who specializes in MS. He is vice president & chief medical officer for MSAA, as well as president of the Multiple Sclerosis Alliance. Additionally, Dr. Burks is a clinical professor of medicine in neurology at the University of Nevada School of Medicine in Reno, Nevada, and a member of the Medical Advisory Board of the National MS Society. He has edited two textbooks on MS, and in the 1970s, Dr. Burks established the Rocky Mountain MS Center in Colorado, one of the nation's first comprehensive MS centers.

To Submit Questions to Ask the Doctor...

Many of these questions were submitted by readers. If you have a question that you would like to ask, please submit your question to:

Readers may also send in questions via email to aborkowski@msaa.com Please be sure to write "Ask the Doctor" in the subject line.

Back