http://rdu.news14.com/content/health_and_fitness/?ArID=79232&SecID=376
1/17/2006 5:25 AM
By: Ivanhoe Newswire

Multiple sclerosis can leave its victims unable to move and in constant pain. It's an autoimmune disease that wrecks havoc on the central nervous system. In some cases, no treatment works. Now, a new therapy stops the disease's progression and gets patients out of bed and back on their feet.

On her 40th birthday, Andra Litman was taken down a path unthinkable. "Unless you're in this body, I don't know how you can begin to imagine," she says.

Doctors diagnosed this artist, attorney, and mother of two with multiple sclerosis, a disease that left her unable to even turn over in bed. Then she started a new treatment. She was out of a wheelchair and on her feet in one month.

Neurologist Olaf Stuve, M.D., Ph.D., says the cancer drug rituximab (Rituxan) is the first treatment to target the B cells in patients with MS, and it could be the first effective treatment for patients when nothing else works.

"The response to the Rituxan in those patients were really dramatic, in terms of not only stopping disease progression, but really helping the patient to recover some of the neurological function," Dr. Stuve, of UT Southwestern Medical Center in Dallas, tells Ivanhoe.

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	Your Health About 400,000 Americans are living with Multiple sclerosis.

Instead of a daily or weekly injection, rituximab requires two infusions every six months. White spots, or lesions on a patient's brain before treatment, are hallmarks of MS. After treatment, they are gone.

Dr. Stuve says, "I think it will be a very effective therapy and probably more effective than what we have available at this time."

Litman says, "The first thought every morning when I woke up for four years was, 'Is it a shot night?'" Now, she can tune her thoughts to what matters most.

Since rituximab only targets one aspect of the immune system, it poses fewer side effects than standard treatments. Dr. Stuve is just beginning a study on using rituximab to treat primary-progressive MS (PPMS), a specific form that affects 10 percent of patients and for which there are no effective treatments.

	Background information:
BACKGROUND: About 400,000 Americans are living with Multiple sclerosis. MS is a progressive and disabling neurological illness that affects the brain and spinal cord. A disruption of nerve signals causes a variety of symptoms that can affect vision, sensation and body movements. MS can also affect cognitive functions. Between 40 percent to 60 percent of patients experience cognitive impairment, which is defined by neuropsychological testing. MS affects about twice as many women as men. It can strike when people are as young as 15 to 20 years old. FORMS OF MS: Most MS patients have one of two types of the disease. The majority of patients have relapsing-remitting MS. This is characterized by clinical attacks, followed by complete or incomplete remission. Most patients develop symptoms like double vision or blindness on one eye, sensory loss, or muscle weakness in one or more limbs. The disease course is highly variable. It can take a very benign course, where patients are virtually symptom-free, or it can be very aggressive for patients. Patients with primary-progressive MS (PPMS) don't have clinical attacks, but they instead accumulate neurological disability from the onset of the disease. The disease course is more uniform in that patients will invariably do a little bit worse than patients with relapsing-remitting. However, there are no effective treatments for primary-progressive MS, while there are effective treatments for relapsing-remitting. Women are more commonly affected with relapsing-remitting multiple sclerosis, whereas men and women are equally affected with primary progressive. TREATMENT: Patients with relapsing-remitting MS are typically treated with global immunosuppressive drugs. These target patients' T cells. Global immune suppression means doctors really target all components of the immune system -- all cells that are involved in an immune response. And that means, according to Olaf Stuve, M.D., Ph.D., a neurologist at UT Southwestern Medical Center in Dallas, that you're likely shutting off parts of the inflammatory cascade that may actually be beneficial to multiple sclerosis patients. Dr. Stuve says: "We know very little about the immune response of multiple sclerosis. But clearly there are many unknowns or adverse affects associated with global immune suppression." RITUXIMAB: Dr. Stuve is studying the use of the cancer drug rituximab (Rituxan) in MS patients. Rituximab targets B cells. Dr. Stuve says there may be certain patients whose B cells, as opposed to T cells, play a dominant role in their disease. In those cases, Rituximab may work where other global immunosuppressive drugs haven't. It also targets just one aspect of the immune system, which makes it, according to Dr. Stuve, a more rational sort of treatment than global immune suppression. Dr. Stuve says side effects experienced from typical treatment and rituximab are fairly similar -- most commonly, flu-like symptoms. However, patients are often treated with chemotherapy, where side effects are much more severe than they appear to be with rituximab. Typical treatments also involve between once-daily and once-weekly injections. With the rituximab clinical trials, patients have one infusion and then around two weeks later, which is repeated every six months -- a big difference from daily or weekly injections. In patients who have been treated with rituximab and haven't responded to other treatments, Dr. Stuve says: "The response to the Rituxan was really dramatic, in terms of not only stopping disease progression but really helping the patients recover some of the neurological function that they had lost in previous month and years. So, the anecdotal evidence in these cases has really impressed me personally of the efficacy of this agent." He believes rituximab is at least as affective as the most effective treatments currently used, and he speculates, emphasizing that this is his personal opinion based on his experience, that "It will be a very affective therapy and probably more effective than what we have available at this time." UNDER STUDY: Dr. Stuve's study involves patients with primary progressive disease. Enrollment just finished, comprising 435 patients at 60 sites in the United States and Canada. Another study involving patients with relapsing-remitting disease is enrolling patients and is being by led by researchers at the University of California in San Francisco.

	For more information, contact:
Aline McKenzie Office of News and Communications UT Southwestern Medical Center 5323 Harry Hines Blvd. Dallas, TX 75390-9060 (214) 648-3404 aline.mckenzie@utsouthwestern.edu http://www.utsouthwestern.edu