• Posted September 18, 2024

Some People With MS May Need Earlier, Higher-Dose Meds

Early, aggressive treatment of brain lesions caused by multiple sclerosis could help ward off faster decline in patients, a new study finds.

Such treatment could prevent or potentially cure paramagnetic rim lesions (PRL), areas of chronic brain inflammation that are linked to more rapid deterioration in MS patients, researchers report.

“Checking PRL levels is not currently a standard part of an MS diagnosis and workup, but our findings suggest that it should be,” said lead researcher Jack Reeves, a medical student at the State University of New York at Buffalo.

MS occurs when a person’s immune system attacks myelin, the protective sheath that coats nerve fibers. The damage to nerve cells causes the brain to shrink as well as symptoms like muscle weakness, stiffness, spasms, vision problems, thinking declines and pain.

Highly effective MS treatments like monoclonal antibodies and immune-suppressing drugs “may lead to better clinical outcomes by preventing PRLs from occurring and should be the gold standard for patients with higher disease activity, meaning they have more brain lesions and more relapses,” Reeves added.

MS patients sometimes develop short-term lesions in the brain which can evolve into PRLs, researchers explained in background notes.

About half of people with MS have PRLs, and about 1 in 5 have four or more PRLs, Reeves said. These lesions cause chronic inflammation in the brain, adding to the degeneration caused by MS.

For the study, researchers used MRI brain scans to assess 155 MS patients for PRLs. They then tracked the patients’ progression for five years.

Overall, researchers found that patients with a higher number of the lesions tended to have faster MS progression.

Preventing new lesions from forming would lower patients’ MS symptoms by nearly 8% over five years, researchers estimated.

Further, treatments that target existing PRLs could reduce MS symptoms by 29% over five years and MS progression by 19%, results showed.

Researchers presented the findings Monday at the annual meeting of the American Neurological Association in Orlando, Fla. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

“PRLs are a potentially useful tool for helping decide the best [treatment] to use, but are just one piece of the puzzle and should be interpreted in context by an experienced neurologist who specializes in MS,” Reeves said in a meeting news release. “Future research should focus on developing new DMTs [disease-modifying treatments] that directly act on existing PRLs.”

More information

The National Institutes of Health has more about multiple sclerosis.

SOURCE: American Neurological Association, news release, Sept. 16, 2024