Ozanimod, an oral drug recently available for the treatment of multiple sclerosis, stops the loss of brain volume in the disease, thus counteracting the accumulation of disability and cognitive deficit. But for it to be truly effective against brain atrophy it must be administered early, because the disease works and creates damage not only in the advanced stages, but immediately. Some experts told all this during a conference on the main innovations that have emerged in the field of multiple sclerosis, a few days after the end of the ECTRIMS/ACTRIMS congress in Milan. In particular, the data on ozanimod confirm the drug’s promises in the fight against multiple sclerosis.
A dual action drug against multiple sclerosis
Multiple sclerosis is a disease of young adults that primarily affects women. Students, more often workers, are challenged by an autoimmune and inflammatory pathology that damages the nervous system, causing motor and visual disorders, fatigue, stiffness, urinary disorders and cognitive difficulties. With a weight that weighs on the person at 360 degrees, both on a physical and cognitive level. Therapies, even if they cannot cure patients, can help manage the disease, helping to stop disability and cognitive disorders. How does ozanimod promise to do, a drug indicated for relapsing forms with a dual mechanism of action: “The drug acts on the one hand at a peripheral level, preventing the lymphocytes from circulating freely, sequestering them in the lymph nodes – says ?Eleonora Cocco of the Binaghi Hospital of Cagliari – on the other hand there are clues that suggest a potential action also within the central nervous system, yet to be defined, where it would help improve the inflammatory process”. The data presented at the congress, Cocco recalled, after 8 years of therapy, confirm the drug’s ability to reduce inflammation, in terms of accumulation of lesions and active lesions, with 76% of patients free from the progression of disability and l ‘87% progression independent of relapses.
Against the loss of brain volume
But ozanimod has also proven effective in reducing brain atrophy, as Matilde Inglese of the University of Genoa recalled: “Cerebral atrophy is a physiological phenomenon, which affects everyone, but if in the general population the loss of brain volume is equal to 0.1% per year, in people with multiple sclerosis the loss is five times as much.” Cerebral atrophy, continued the expert, is a direct measure of the neurodegenerative process caused by the disease and is related to both physical disability and cognitive deficit: “Ozanimod has shown that it can reduce brain volume loss by approximately 30% compared to a first-line drug such as interferon beta-1a, already at one year, and the benefit is maintained at two years. This effect is preserved above all at the gray matter level.”
Preserving cognitive functions: the help of drugs and prevention
Cognitive deficit in people with MS is a well-known problem, although only recognized in the last twenty years, thanks to the fact that it often does not present itself immediately either to the patient or to the neurologist, added Roberta Lanzillo of the Federico II University of Naples: “Ozanimod was the first drug whose effect was also evaluated on cognitive functions. The goal was to understand if it could help stabilize them, and already after six months the drug showed that it improved the speed of processing information.” A study carried out on patients in the early phase, with low disability and with a limited history of previous treatments, showed that cognitive functions improve already after one year, explained Lanzillo: “These data confirm the need to intervene promptly, even more so considering that the cognitive and cerebral reserve are not recoverable”.
by Letizia Gabaglio
However, the loss of cognitive reserve can be prevented: “Clinical recommendations should invite patients to have an active lifestyle, but also to read, study, train their brain – added Paola Cavalla, Head of the Multiple Sclerosis Center, SC Neurology 1 DU, Department of Neuroscience and Mental Health of the City of Health and Science of Turin – We know that education and cognitive training can be protective against cognitive decline, as can an active lifestyle and a balanced diet”. As well as high levels of vitamin D, the experts conclude: “We know in fact that in people with hypovitaminosis D the cognitive deterioration is more marked”.