WebMD Live Events Transcript

According to the Multiple Sclerosis Foundation, more than 350,000 persons in the United States today are living with the multiple challenges of multiple sclerosis (MS). In observance of National MS Education and Awareness Month, neurologist Howard L. Weiner, MD, joined us on March 3 to answer your questions.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Weiner. What are the biggest challenges for the MS patient today and what are some of the newest solutions that are being looked into as far as treatment, quality of life, and pain management?

WEINER:
The first and biggest challenge is to be followed carefully by your doctor, to undergo therapy and have the therapy monitored. Another series of challenges relate to lifestyle: depending on the type of MS, not letting the MS interfere with the patient's lifestyle, to have a positive attitude and to realize there's a lot of research and advances in MS that have happened in the last 10 years and that are ongoing.

"We really need more time to follow patients and learn about what happened to protect against any unwanted side effects."

MEMBER QUESTION:
Tell me more about the recent drug, Tysabri, pulled from the market because of one death.

WEINER:
Tysabri, as everyone knows, was recently pulled from the market because of two serious side effects, one of them death. The scientific community and Biogen Idec and Elan [Tysabri's makers], are now examining very carefully all patients treated with Tysabri. It is generally believed the complication was related to Tysabri, although more data is needed.

Tysabri works by stopping white blood cells called T cells from entering the brain. It is believed that it also stopped important T cells which keep a certain virus in the brain under control. Because these T cells were blocked, the virus was reactivated and led to these serious side effects.

What is needed now is longer-term follow-up on all patients who received Tysabri to see how common this is, whether there are any patterns and whether it occurred in patients receiving Tysabri alone or only in patients receiving Tysabri plus Avonex. We don't know the answer.

It was absolutely correct to stop treatment with the drug at this time because it is theoretically possible, if more people were treated and this is a common side effect, there would be many serious side effects and deaths. It is also possible that this is a very rare occurrence and after watching and monitoring people, the drug could be reintroduced. We really need more time to follow patients and learn about what happened to protect against any unwanted side effects.

MODERATOR:
How do you feel about the fast-tracking drugs like Tysabri?

WEINER:
I think it is important to fast track drugs. The safety profile of Tysabri was very good. Obviously one can do Monday morning quarterbacking and say this drug perhaps should not have been fast tracked, but I believe it was logical to get it on to the market.

MODERATOR:
Do you see any other drugs coming to market soon for MS?

WEINER:
There are many drugs being tested and I believe there are a number of drugs that could come to market in the next five years. There are also drugs approved for other indications that have shown some efficacy in MS and could be used now in MS patients. There are immunosuppressive drugs used in transplantation and drugs used for certain other immune conditions that have been shown to help MS patients, and these drugs could be used by physicians if the patients required them.

MODERATOR:
How might those differ from the effect of Tysabri?

WEINER:
Each immunosuppressive drug works in a different way. The immunosuppressive drugs I referred to have been given to a large number of patients without the progressive multifocal leukoencephalopathy (PML) side effects.

MEMBER QUESTION:
What do you see coming for pain management? Are there things besides drugs I should be trying?

WEINER:
Pain management is very individual situation. If someone has very bad pain, there are specialized pain clinics that I refer my patients to, as there are so many aspects and avenues to treat it.

"I think people should keep in mind that there are many who have MS that do very well with their illness and that we have treatments that can help slow MS and decrease the disability."

MEMBER QUESTION:
I have an "odd" type of relapsing remitting MS. My "flares" are always many years apart and always seem to link or follow hormonal changes, such as pregnancies and now menopause. Would hormone replacement therapy (HRT) possibly be a help to me? I seem to be getting weaker at an alarming rate.

WEINER:
There's no evidence that HRT would make a major difference, but you should check with your neurologist and endocrinologist.

MEMBER QUESTION:
I am currently on Betaseron for my diagnosis of MS. I am currently trying to be very active in my workouts and weight training. I am 24 years old. Is it OK to take protein, creatine, and other supplements while on the medication? Also, I know another MS patient around the same age who is taking Betaseron and steroids. Will he have any medication reaction problems by taking both? Thank you for your time.

WEINER:
It is perfectly fine to take Betaseron with intravenous steroids such as methylprednisolone (Solu-Medrol) which is commonly given for MS attacks. It is also fine to take protein dietary supplements or vitamins with Betaseron.

MEMBER QUESTION:
My biggest challenge was getting a diagnosis. What do you recommend for someone who is trying to get a definitive diagnosis? What tests absolutely should be done?

WEINER:
The most important tests are the MRI and spinal tap. On the MRI one looks for spots consistent with MS. The spinal tap shows abnormal protein and gamma globulin patterns that are often typical of MS.

"In general, the MS patient should try to do as much as they can in their life that they normally would do."

MEMBER QUESTION:
My neurologist has been trying to diagnose me with MS for the past three years. I had optic neuritis in 2002. Now my pressure in the same eye has gone up to 28. Is there a link between MS and eye pressure?

WEINER:
There's a link between MS and optic neuritis, but I don't know of a link between MS and eye pressure.

I think people should keep in mind that there are many who have MS that do very well with their illness and that we have treatments that can help slow MS and decrease the disability. In general, the MS patient should try to do as much as they can in their life that they normally would do.

MODERATOR:
Dr. Weiner, we know that you need to return to your patients, but before you go could you please tell us about your book?

WEINER:
I published, last week, a book called Curing MS: How Science Is Solving the Mysteries of Multiple Sclerosis . Both patients and physicians have found it very useful. MS is a very complex disease, and in the book I try to explain the complexities and how drugs have been brought to market. I present a 21-point hypothesis on the cause and treatment of MS and what it will mean to cure the disease. I worked on the book for five years, which summarizes my 30 years of experience. The book is available on Amazon or in libraries and if patients or their families are interested in my very detailed views of the disease, I would suggest they take a look at the book.

MODERATOR:
Our thanks to Dr. Weiner for joining us today. And thanks to you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, please read Curing MS: How Science Is Solving the Mysteries of Multiple Sclerosis .

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