There are so many killjoys out there who think progressive MS is an intractable problem and that we have no treatments that work. Incorrect! I would like to remind these killjoys of the cyclosporine and methotrexate studies from over 25 years ago in people with chronic progressive MS (SP & PPMS). Both these studies were positive and had an impact on disability progression. Cyclosporine was dropped because of renal toxicity and hypertension and methotrexate was dropped because most people think that protecting the upper limbs in people with progressive MS is not worth doing.
The above is water under the bridge, right now we should be celebrating the recent results of ocrelizumab in PPMS and siponimod in SPMS, results. The killjoys say these results are not good enough. What do you want? Please remember a 25% difference in progression rates atat 2-3 years of follow-up may be 50% at 5 years and 75% at 10 years. I agree that if you have progressive MS these results are not what you want; you want to get back to normal. However, these drugs are not designed to restore function; for that to occur we need new therapies to add-on to anti-inflammatory therapies. Please be positive and celebrate the recent successes in progressive MS. The tragedy is we had similar successes over 25 years ago and we didn’t build on them. This time we need to seize the day; carpe diem!
The Multiple Sclerosis Study Group. Efficacy and toxicity of cyclosporine in chronic progressive multiple sclerosis: a randomized, double-blinded, placebo-controlled clinical trial. Ann Neurol. 1990 Jun;27(6):591-605.
Goodkin et al. Low-dose (7.5 mg) oral methotrexate reduces the rate of progression in chronic progressive multiple sclerosis. Ann Neurol. 1995 Jan;37(1):30-40.
Methods: A randomized, double-blinded, placebo-controlled, clinical trial of low-dose, weekly, oral methotrexate was performed in 60 patients with clinically definite chronic progressive multiple sclerosis (MS) attending a referral-based outpatient MS clinic. Study patients were 21 to 60 years old with a disease duration of longer than 1 year. Patients’ Expanded Disability Status Scale scores were 3.0 to 6.5 (ambulatory with moderate disability). Patients were first stratified by Expanded Disability Status Scale scores, 3.0 to 5.5 and 6.0 to 6.5, and then were randomized to receive methotrexate or placebo treatment. Treatment consisted of weekly, oral, low-dose (7.5 mg) methotrexate or identical placebo for 2 years, followed by observation for as long as 1 year. A composite outcome measurement instrument was used and consisted of (1) Expanded Disability Status Scale, (2) ambulation index, (3) Box and Block Test, and (4) 9-Hole Peg Test.