Multiple Sclerosis treatment. Neuromyelitis optica. Tysabri. Precision medicine. Part 2 of 3. 8
You published a review of multiple sclerosis advances in diagnosis and treatment. It was printed in the leading journal Nature Reviews Neurology. Dr. Anton Titov, MD. Your review is titled “Decade in review: multiple sclerosis. New multiple sclerosis medications. Personalized medicine for multiple sclerosis.” Dr. Anton Titov, MD. What are leading breakthroughs in personalized medicine for multiple sclerosis treatment? Third area of breakthroughs in multiple sclerosis is this. Dr. Paul M. Matthews, MD. It is in the genetics of multiple sclerosis. We talked about this earlier in the interview. This work began in the latter part of the first decade of this century. There was the first of the large genome-wide association clinical trials in multiple sclerosis. Results began to be published from the international consortium. Dr. Anton Titov, MD. This was a revolutionary development for two reasons. First, it clearly highlighted that predominance of inflammatory genes as susceptibility factors for multiple sclerosis. It clearly emphasizes to my mind that multiple sclerosis is a primary autoimmune disease. Dr. Paul M. Matthews, MD. The second aspect of this work has very profound implications for multiple sclerosis diagnosis and treatment. It has also significance for medicine more widely. The genetics consortium represented a grouping of scientists from all over the globe. Dr. Paul M. Matthews, MD. All multiple sclerosis experts worked together with common purpose. They joined their data together. They made multiple sclerosis research results freely available for development by the medical community. That allowed the large volumes of data to be assembled. We needed that. Breakthrough #4 was the discovery of the aquaporin 4 antibody and its close relationship with neuromyelitis optica [NMO]. It allowed NMO to be defined as a distinct disease entity. Neuromyelitis optica is different from traditional multiple sclerosis. This has enabled patients with NMO to be carefully identified from diagnosis. It allowed the correct treatment to be delivered. Dr. Paul M. Matthews, MD. Because these patients don’t respond to multiple sclerosis treatments well. They may even show worsening with conventional multiple sclerosis therapies. Moreover, the spectrum of NMO [neuromyelitis optica] has been broadly expanded. We recognize that MNO involves much more than we thought before. Dr. Anton Titov, MD. We have talked about personalized medicine. It has been exciting to us precision medicine in multiple sclerosis. Precision medicine rescued the use of Natalizumab (Tysabri) after the recognition of its association with progressive neurological disease. It is Progressive Multifocal Leukoencephalopathy infection, PML. Initially the identification of Progressive Multifocal Leukoencephalopathy posed a terminal threat to regulatory approvals of this multiple sclerosis medication. However, we discovered methods of identifying patients at risk for PML. Dr. Paul M. Matthews, MD. We can monitor patients closely over time to serially evaluate this risk of Progressive Multifocal Leukoencephalopathy. Therefore, natalizumab is used again to treat multiple sclerosis. Dr. Anton Titov, MD. Rational decisions can be made between a patient and a doctor about whether natalizumab should be used and for how long. Tysabri is an effective multiple sclerosis medication.
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