New therapies for Multiple Sclerosis

Last Saturday we attended the MS Forum VI in the Mandarin Oriental of Brickell Key, Florida, where we discussed with prestigious academicians and colleagues the latest developments in the treatment of myriad clinical presentation of Multiple Sclerosis. Amongst the topics that were exposed about, we selected to discuss three with you:

  1. Anti-CD20 Monoclonal antibodies
  2. Oral therapies for relapsing MS
  3. Autologous Mesenchymal Stem Cells.

A – Anti-CD20 Monoclonal antibodies

These antibodies have been used to deplete the B cells proliferative disorders like leukemia and Hodgkin’s Disease for a few years already. CD-20 is a transmembrane calcium channel implicated in the B cell activation and differentiation; anti-CD20 target the B cells in an intermediate stage of their evolution, safeguarding the needed long-term immunological memory and the production of cells after depletion. The drug Rituximab was the first one approved for auto-immune disorders but it soon generated side effects due to the patients’ formation of anti-chimeric antibodies. At present there are many humanized versions of it that are being tested in clinical trials. In 2004 the Food and Drug Administration (FDA) approved the use of Natalizumab for the treatment of Multiple Sclerosis, heralding the era of MABs for its treatment. Alemtuzumab and ocrelizumab followed in the pipeline and were approved; at present ublituximab and ofatumumab are in the Phase III of their clinical trials. When we discussed a young patient with new onset of MS, most of us opted for Natalizumab as the drug of choice because it shows greater efficacy to thwart the symptoms early on with the caveat that it also elicits a quick rebound phenomenon.

B – Oral therapies for relapsing MS

Even though Interferon B or Copaxone are often the first drugs of choice, many patients prefer the oral therapies like Fingolimod, Teriflunomide and Dimethyl Fumarate. In 2010 Fingolimod became the first FDA-approve oral therapy. In the Confine and Define clinical trials, Dimethyl Fumarate has been shown to reduce the relapse rates, the number of lesions in the MRI scans and the physical disabilities; its efficacy might be due to its anti-inflammatory properties to decrease oxidation; it modulates the sphingosine-1-receptor and decreased the lymphocyte migration to the CNS. Compared to Interferon beta-1a has been shown to reduce 52% the yearly relapses in one study; after one year, 13% of patients did not have any relapses. In the Temso trial, Terifluamide reduced the yearly rates of relapses, the MRI lesions and the physical disability limitations; the drug blocks the pyrimidine synthesis, which decreases the inflammatory process, including the production of white cells in the CNS and the protection of the myelin sheaths of the nerves.

C – Autologous Mesenchymal Stem Cells

Stem Cell transplant is an emerging, promising new therapy for MS, which has been discussed in the professional and public forums for the past few years. Patient that come to the office invariably ask us: “what do you think about Stem Cells, doctor?’ However there has been a dearth of reliable clinical trials with proper peer supervision until the early results of a Swedish study where presented in the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) that was held in Stockholm last September. The researchers discussed the positive data from the Nordic study of the Autologous Hematopoietic Stem Cell Transplant (AHSCT) that implies the harvesting of bone marrow from the patient and the use of chemotherapy to wipe out the rest. The patient’s own stem cells are then re-introduced in another surgical procedure. The results of a phase III randomized  clinical trial showed that the NEDA (no evidence of disease) in the cohort treated with the AHSCT was 78.% compared to only 2.97% of patients treated with the conventional methods; the risks are the expected ones for the surgical interventions.

What do you think? Please tell us.

Don’t leave me alone.




First Southeast Cannabis Conference and Expo

On June 10, 11 2017, we attended the first major gathering of professionals, industry representatives and general public that focused on the multiple uses and presentations of Cannabis and its extracts in South Florida. As we have already discussed in our previous articles on the medical use of Cannabis, the extraction and purification of the CBD component has allowed its certification and commercialization for care issues.

Walking through the exposition hallways we met interesting people of all walks of life. Right upfront there was a station from “Weedmaps”, an information company that has been called “the Amazon of hemp.” According to Carrissa, the lovely lady serving as its hostess, it is a fully integrated site for all the issues related to the use of marijuana.

A few paces away there was a über-multi-coloured and lively presentation of “MagicalButter”, a state-of-the-art botanical extractor to prepare edibles. Dalton, the smiling guy that appears as the image of this article, patiently explained the steps to prepare smoothies, dressings and other delicacies.  A few paces away I found an example of CBD – innovation. Lawrence, a sales manager from “Quantum Group Distribution”, showed me how a small nebulizer delivered its necessary dosage in a fast, clean way.There was also space for entertainment options as Kathy explained the cruise ship schedules offered by “Bhang Travel” in accommodations of “MSC.”

The educational activities were informative; unfortunately we could only attend a few of them but we harvested many pearls from that experience. Attorney Michael Minardi, who represents clients that were prosecuted for consuming and/or planting of marijuana, explained to the defense basis on the grounds of “medical necessity”, The use of Cannabis for healing purposes must be supported by the medical condition of the patient and the unavailability of other treatment options for severe pain and other ailments. He told us that since the times of the British colonies, the American settlers have defended the use of local remedies against abusive authorities. He gave us several examples of cases he had litigated across the nation; it seemed that once the need for Cannabis is established and the possibility of trafficking is ruled out, most prosecutions are gracefully dismissed by the juries for the relief of defendants and their families.

Montel Williams, a former Navy service man and famous entertainer, made us all laugh with his spontaneous account of the many instances when he was detained at the airport security because he was carrying a pipe; his life dramatically changed when he was diagnosed with Multiple Sclerosis.

Dr. Stuart Titus, an entrepreneur from California, explained to us that in the USA there was not an established tradition of Herbal Medicine like in India, China or even Europe and there was a suspicion of medicinal products that could not be thoroughly quantified. He believed that the sustained efforts at scientific research, industry methods and clinical research will eventually overcome that disconnect and facilitate its medical use.

Cheryl Shuman, dubbed as the “Martha Stewart of Marijuana” by the media, narrated how since she was diagnosed with cancer several years ago she has been using marijuana for medical purposes. As she wanted to share her experience with the public she began a high profile campaign in the media. She had to overcome plenty of vitriol from many quarters but she managed to focus the discussion on patients’ right to an alternative Medicine tool. She eventually became a very successful Cannabis business entrepreneur. In her closing argument she became very personal as she shared some privy details about her present medical condition, which was a highly charged emotional moment. We wish her a successful treatment and recovery period as she’s in our prayers.

The unrelenting scientific and clinical evidence that Cannabis, and specifically the CBD component, has multiple uses in chronic diseases will certainly promote many more conferences like this one in the near future in our area and the rest of the nation.

What do you think? Please tell us.

Don’t leave me alone.