Top 5 highlights of 2013
The year 2013 saw many highlights in MS research. Here are our picks for the Top 5 developments of the year.
1. MS is a global problem. Where once MS was seen as a disease that primarily affected people of northern European ancestry, there is a growing recognition of the impact of MS in different countries and peoples around the world. Over the past year we’ve seen a great deal of MS research in “non-MS regions”, such as the Middle East, South America and Asia, which should lead to a better understanding of the genetics of MS. With more research and funding, the hope is that people with MS worldwide will have improved access to the medical care, new therapies and support services they need.
2. Put a halt to salt? Salt has been high on everyone’s hit list for years as a health problem, most notably for older people with high blood pressure. In the U.S., the daily consumption of salt – mostly from fast foods and processed foods – is estimated to be 3,500-6,000 mg (about 1.5-2.5 teaspoons), much higher than the 1,500-2,300 mg per day recommended by the American Heart Association and other groups. (The AHA’s “Salty Six”: bread, cold cuts, pizza, canned soups, poultry and fast-food sandwiches/hamburgers.)
Salt appeared on our radar this year with a new study that found that people with MS on a high-salt diet were four times more likely to have a relapse compared to those on a low-salt die (Faraz and colleagues. ECTRIMS 2013; abstract 119) One reason: higher salt consumption appears to be associated with more inflammatory activity in the brain. More studies are needed, but salt consumption may soon join the list of environmental factors that influence MS, such as Epstein-Barr virus, low sunlight exposure and smoking.
3. Ushering out the old. We began the year with a prediction that the traditional injectable therapies – the interferons and Copaxone – would begin to make way for the next-generation oral drugs (see Beginning of the end of the injectables?). The injectables have had a 20-year run, but the newer drugs appear to as effective, more convenient and a lot less painful.
4. Ushering in the new. Two new oral drugs became widely available in 2013. Aubagio (teriflunomide) was approved in Canada late in the year (following approval in the U.S. in 2012). The drug is about as effective as the injectables and side effects seem manageable. The downsides: you need to undergo an elimination protocol to remove it from your body if you’re planning a pregnancy (men as well as women), you need blood tests to guard against liver damage, and some people experience hair thinning.
The biggest event of the year, however, was the launch of Tecfidera (dimethyl fumarate), which hit the ground running when it got approval from the FDA and Health Canada in the spring (still awaiting approval in Europe). Tecfidera is likely to be even more effective than Aubagio. The downsides: you need to take it twice a day (if you forget a dose you’re no better off than with a placebo), and side effects such as flushing and stomach upset are common. With oral Gilenya already available, people with MS now have three oral medications from which to choose. It’s too early to say how well these next-gen drugs will do in slowing the development of disability, but we’ll be following them closely to see how they perform in the real world.
5. The promise of personalized medicine. More treatment options mean a person has a better chance of finding a more effective medicine. It also means that you don’t have to struggle for years with an underperforming drug just because there’s nothing else on the shelf. Some countries have developed more stringent criteria for assessing whether or not a medication is working (See Getting the most from multiple sclerosis treatment and our Interview with Dr. Mark Freedman.) The next step will be to determine if treatments new and old fulfill the promise of slowing the development of disability and enable people to live free of MS disease activity.
A great deal more work needs to be done. In the coming year, there will be new insights on the MS disease process and we’ll see more information on how well people are doing on the newer therapies. We can also hope to see if current and emerging therapies provide any benefit on the neurodegenerative aspect of MS – the all-important missing element needed for people with progressive MS.
Throughout the coming year, MSology will be at all the major MS meetings to provide you with updates on all the latest developments, special features and interviews. We hope this information helps you in your daily challenge of living with MS.
To Msologists worldwide – Happy Holidays and our best wishes for 2014!
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