Why more women than men 
suffer from multiple sclerosis? (4)

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Multiple sclerosis in women and men. Why more women than men suffer multiple sclerosis? Could multiple sclerosis therapy be used differently in men and women? Because right now the therapies are not gender differentiated. Right! Be very careful when you use a word gender. There’s a difference between biological sex and gender. We see a sex-related effect with multiple sclerosis. So multiple sclerosis is another autoimmune disease. There appears to be inflammation, neurological inflammation. But it results in a systemic effect. So again we suspect it’s because of a number of factors. One of them being a very specific immune cell which is considered to contribute to the persistent inflammation in multiple sclerosis. Perhaps again it’s that women are predisposed to activating those cells under certain circumstances. Now there are no different medications for multiple sclerosis patients based on male or female sex. Do you think in the future we are going to see their different multiple sclerosis medications for men and women? and potentially different dosages or routes of administration of medications based on sex? Perhaps again it’s a very good point to make here. So what we’ve learned over decades (and unfortunately it’s not necessarily applied here) is that the way women or females metabolize drugs is very different to males. There are liver enzymes which are different in females. Or their levels are different in females and males. Fat distribution is different in females and males. Generally speaking females tend to be smaller than males. So all those factors influence what we call bioavailability of medications. In addition to that the concentration of a drug in the blood might have a completely different outcome in terms of dose between males and females. Added to that there are certain factors that are different between males and females. In terms of certain pain levels, we know that different immune cells elicit different pain response in males and females. When you look at all those contributing factors, absolutely we should be aware of dose and mechanism of a drug when you’re treating males and females. In the context of autoimmune diseases, there are some very effective biological medicines that target some of immune system factors. These factors create that persistent inflammation in autoimmune disease. What is important to appreciate is that for males and females the bioavailability and the metabolism of those biological medicines may indeed vary. Right now a little consideration has been given to dosing of medications differently in males and females.