In this full-length doctor's interview, Daniel Jacobs, M.D., explains how a new drug targets destructive white blood cells in MS patients and could stop the disease in its tracks
July 21, 2003
Ivanhoe Broadcast News Transcript with
Daniel Jacobs, M.D., Neurologist,
TOPIC: New Hope for MS
How does multiple sclerosis affect a patient?
Dr. Jacobs: Multiple sclerosis can cause disability in a lot of different ways. People can have trouble with their vision and trouble using their limbs. They can have spasticity, pain, fatigue and difficulty with their bladder. All of these symptoms tend to be progressive and become worse over the course of the disease.
Tell me about the treatment of MS using shots.
Dr. Jacobs: Patients with relapsing/remitting multiple sclerosis need to take shots, either once a day, once every other day, or once a week to control their symptoms of MS and their relapses.
What are some problems with this type of treatment?
Dr. Jacobs: Some people donít like to take shots. Some people have injection-site reactions. Some people are scared of needles. Some people have a difficult time physically manipulating the needle to give themselves a shot, and for some patients, the medicine is not even enough to control their symptoms of MS.
Why do some patients stop taking the shots?
Dr. Jacobs: A huge number of MS patients donít take the shots because they feel they're either too cumbersome or not likely to be effective in MS, so new treatments are desperately needed.
Tell me about the history of this new treatment for MS.
Dr. Jacobs: Campath-1H is a monoclonal antibody that attacks T-cells, which are the cells that attack the myelin in multiple sclerosis. This drug is given as an infusion. Patients donít have to get daily shots. They can get an intravenous infusion of drug for five days a year without shots, and it will reduce their relapses and improve the MRI signs of multiple sclerosis. We have not studied it in a huge number of patients yet, so we cannot make any claims about efficacy. But the pilot studies suggest that itís very effective and maybe more effective than the existing treatments for multiple sclerosis.
How much more effective?
Dr. Jacobs: The existing treatments will reduce relapses by about 30 percent on average in all patients. That means that they will continue to progress with their multiple sclerosis, but perhaps not as fast as if they didnít take the shots. This drug may be more effective than that. I canít give you percentages. I think we need more data to do that, but it looks like it may be substantially more effective.
Explain to me how Campath-1H works.
Dr. Jacobs: The drug is a new type of drug called a monoclonal antibody that attacks certain types of white cells that attack the brain and spinal cord and cause multiple sclerosis. It helps prevent the attacks of multiple sclerosis. The drug is a new class of drug called monoclonal antibodies, which attack certain white blood cells that attack the brain and spinal cord and turn these white blood cells off. As a result, multiple sclerosis relapses can be eliminated.
What kind of hope does that offer for MS patients?
Dr. Jacobs: If we can treat the patients early enough in their disease process, we can prevent the plaques from forming in the first place. We can presumably reduce their long-term disability. Thatís the hypothesis of this study.
I know itís early, but how exciting could this be?
Dr. Jacobs: Once a certain amount of brain damage has occurred, unfortunately, you canít go back and put Humpty Dumpty back together again. The patient will most likely have a certain amount of disability no matter what drugs are given to them. On the other hand, if you can stop MS very early on, in the first three or four years of disease, you have a chance of reducing the amount of brain damage (preventing the accumulation of disease burden as measured on MRI), and thereby reducing the disability at five, 10, 20, 25 years down the road. Thatís extremely exciting.
The patient that we are going to talk to is a hopeful candidate for this trial. How could her involvement improve her MS symptoms?
Dr. Jacobs: She will be [a candidate] if sheís eligible for the trial. She wonít have to take the shots. Sheíll just take a five-day infusion of the drug without shots and we will assess her with periodic office visits and MRI scans. As I mentioned, the preliminary or pilot data suggests that this drug may shut down the new MRI abnormalities as well as greatly reduce the number of relapses, maybe even eliminate them.
What are the criteria to participate in this study?
Dr. Jacobs: The criteria for entry into this study are patients who have never been treated with existing treatments of MS. These are the so-called alphabet treatments -- A, B, C, R drugs -- Avinex, Betaseron, Copaxone and Rebif. Patients have to have had at least two relapses and to have had the disease for less than three years, or at least have had neurologic symptoms for less than three years.
What would make a patient ineligible for participation?
Dr. Jacobs: In a clinical trial, we focus on a certain subset of patients that we hope will have the best chance of helping. It doesnít mean the drug wonít work for patients outside of the subset, but the criteria are fairly rigid because the study has to be done according to standards set out by the Food and Drug Administration.
Talk about how many candidates you have and why they make good candidates.
Dr. Jacobs: Weíre looking for as many patients as we can get that meet the criteria, and again, weíre looking for patients that are relatively early in the disease course who have MRI abnormalities and who have not yet been treated with the existing treatments.
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