Understanding Multiple Sclerosis and the Role of Specialty Care

What Is Multiple Sclerosis (MS)?

Multiple sclerosis is a chronic and often disabling neurological disease that affects the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves.

“In MS, the body’s immune system attacks the healthy tissue, specifically myelin,” Renee Baiano, PharmD, CSP, Clinical Program Manager at AllianceRx Walgreens Pharmacy, told PharmaNewsIntelligence in an interview.

Signs and Symptoms

“Myelin is the protective layer that insulates nerve fibers. When damaged, myelin disrupts signals to and from the brain,” Baiano continued. “This interruption of communication signals causes various symptoms such as numbness, tingling, memory problems, pain, fatigue, blindness, and paralysis.”

Symptoms of MS can include numbness or tingling in the limbs, vision problems, fatigue, muscle weakness, difficulty with coordination and balance, bladder and bowel problems, cognitive impairment, and mood changes. Baiano mentioned that symptoms could come and go or worsen over time, depending on the individual.

Because MS is an unpredictable condition, it impacts everyone differently, and these losses may be temporary or long-lasting, making diagnosis and treatment challenging.

What Causes MS?

Although the exact cause of multiple sclerosis is not yet fully understood, it is believed to be a combination of genetic and environmental factors that trigger an autoimmune response in the body.

Researchers have identified over 200 genetic variants that are associated with an increased risk of developing MS. Additionally, MS is more common in northern and southern latitudes, including Canada, the Northern US, New Zealand, southeastern Australia, and Europe, and people of northern European descent are at the highest risk of MS. This suggests that environmental factors, such as exposure to viruses, may play a role in the development of the disease.

People with other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis, may also be at increased risk of developing MS. Other risk factors, such as smoking, have been shown to increase the risk of developing MS and exacerbate the symptoms and progression of the disease.

While these factors have been related to an increased risk of MS, it is important to note that not everyone with these risk factors will develop the disease, and some people who develop MS may not have any known risk factors.

Treatment Options

“There is no definitive blood test for MS,” explained Baiano. “MS is diagnosed based on the healthcare provider ruling out other conditions, reviewing the patient’s medical history, and performing specific tests and exams.”

Baiano indicated that healthcare providers will assess for evidence of damage in at least two separate areas of the central nervous system — and if the damage occurred at different points in time. Often, an MRI and cerebrospinal fluid analysis are evaluated to speed up the diagnostic process.

“While MS is not a curable disease, there are effective strategies available to help modify or slow the disease progression, treat relapses, manage symptoms, improve function and safety, and address mental health,” Baiano emphasized.

Although there is currently no cure for MS, various treatments are available to help manage symptoms and slow the progression of the disease. These treatments can include medications to modify the immune system, medications to manage symptoms, physical therapy, and lifestyle changes.

“These medications target the immune system and reduce the development of new lesions and inflammation,” clarified Baiano. “Each person’s body may respond to medication differently, and the medication that is the best option for one person may not be the best for another person.”

Baiano pointed out that there are many factors that the healthcare provider and patient would want to review before selecting the best treatment option. Some factors to consider include the route of administration (oral, infusible, or injectable), side effect profile, and medical history.

Future Treatment Options

According to Baiano, many new and exciting MS treatments are currently in the developmental pipeline. While some of the medications are oral, others are injectable/infusible. And compared to prior treatments, many new products target different pathways in the immune system.

“Several products in the pipeline target Bruton’s tyrosine kinase (BTK). Interestingly, BTK products were originally brought to the market as a cancer treatment but have shown positive outcomes for MS patients,” Baiano revealed. “Inhibition of BTK, which is involved in MS pathways, may prevent brain damage and improve MS outcomes.”

Some potential products include dosing and formulation changes to existing medications. “For example, a long-acting form of glatiramer would only need to be administered once every four weeks, compared to the current forms, which are given daily or three times per week or a subcutaneous version of Ocrevus,” explained Baiano.

In addition, Baiano expects to see some biosimilars enter the future market, such as Sandoz’s biosimilar for natalizumab. 

The Role of Specialty Pharmacies

Specialty pharmacists can play a crucial role and provide personalized support and guidance to help patients with MS manage their condition effectively, ultimately improving their quality of life.

“Specialty pharmacists are integral members of the healthcare team and are instrumental in helping patients get the best results from their treatment,” insisted Baiano. “Identifying barriers to adherence and educating patients on the importance of taking their medication can increase the patient’s chance at disease improvement.”

Beyond medication guidance, specialty pharmacists can also provide education and advice on lifestyle changes that can help manage the symptoms of MS, such as exercise and diet. Baiano suggests that patients take time to focus on themselves, listen to their minds and body, and get involved in the MS community.

“Whether it is helping patients take their medication the proper way or notifying their prescriber about new adverse events, a specialty pharmacist plays a vital role in helping patients manage their condition,” concluded Baiano.