Giving powerful drugs to patients who have suspected MS could spare them debilitating symptoms

Giving powerful medication to patients suspected of having multiple sclerosis – but who are not yet formally diagnosed – could spare them a lifetime of debilitating symptoms, experts believe.

At present, the most potent drug treatments that tackle the underlying causes of the neurological disease are reserved for those with more advanced cases.

But a growing body of research suggests giving these types of medicines before symptoms worsen could keep the condition stable for up to a decade.

Now in a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place.

Some 130,000 people in Britain have multiple sclerosis (MS). The disease causes the body’s immune system to attack nerve cells in the brain and spinal cord, which affects patients’ bodily sensations and gradually leads to mobility and eyesight problems, muscle spasms, bladder issues and fatigue. There is no cure.

There are several types, but the most common is what’s known as relapsing and remitting, which affects roughly 80 per cent of patients and causes symptoms to flare up sporadically, sometimes with years in between.

Most first seek medical help after experiencing a period of telltale symptoms, such as tingling and numbness in the arms and legs. But getting an accurate diagnosis is challenging.

Doctors perform brain scans to look for early signs of nerve damage in the brain, and a lumbar puncture to analyse spinal fluid for signs of MS-related damage.

Some patients will have several visible lesions – dark or light spots of scarring (sclerosis) in the central nervous system that appear different from normal tissue – but others may develop these later.

For one in five suspected patients, the lesions don’t develop at all and their diagnosis is not in fact MS. 

So doctors have been reluctant to offer potent medicine that changes brain tissue at early stages to patients without several lesions, in case it turns out to be unnecessary.

Patients in the new study will be given a low-risk drug called natalizumab before their diagnosis is confirmed, to see if those with little brain damage can benefit.

Professor Klaus Schmierer, a neurologist at London’s Barts Health NHS Trust, plans to recruit 40 patients who have visited their GP or A&E unit with suspected MS. All will undergo MRI scans to check for at least one brain lesion. 

Twenty volunteers will be given a two-week course of natalizumab, which works by stopping the immune system’s fighter cells from reaching the brain and spinal cord and attacking nerves. 

The drug stays in the body for only eight weeks – while others can remain for 18 months – so if patients do not have MS, they can come off it without risking long-term effects.

The other 20 patients will be given a placebo.

In a world-first trial, British experts will explore whether treating patients at the earliest possible stage could prevent some from deteriorating in the first place (stock image)

Experts say this reflects a similar treatment pattern to stroke – where it starts right away, without waiting for a confirmed diagnosis. Scientists say the new field of research marks a ‘change of mindset’ in the understanding of how the condition develops.

Previously, doctors believed that damage in the brain that builds up after diagnosis indicates that the disease will progress. 

Now, experts think the earliest signs of dead cells may be crucial, too, and giving highly effective drugs early may stop the disease in its tracks.

‘We’ve realised there are signs that indicate how the disease will progress from the onset,’ Prof Schmierer says. 

‘In early stages the brain can help reboot the connections that MS might have damaged. So if we start treatment early rather than waiting, might it give patients a better chance of really long-term remission? It could represent a huge change in quality of life for patients.’

The new study follows a seminal paper showing the impact of the regime. An Australian paper published in the Lancet in April 2020 showed patients who started taking the drugs within the first two years after diagnosis were less likely to see their disability worsen. After ten years, the patients who took the drugs early barely saw their condition change.

Two women who understand the importance of early treatment are sisters Vikki Langford and Zoe Bowman, who were diagnosed with MS within weeks of each other in 2017. 

While Vikki had access to potent treatments within weeks, due to her brain lesions, Zoe, who has a less common type of MS which progresses very slowly, had to wait nine months.

Vikki, 56, from York, said: ‘Time is always of the essence. While we don’t know what would have happened if Zoe had got earlier access to treatment, her symptoms worsened while she was waiting.’