NEW DELHI: For Rishab Shukla (name changed), it was a sheer stroke of luck. In 2021, the 40-year-old from West Delhi was visiting an orthopedician to figure out why he struggled to walk normally and fell on the ground every now and then. Dr Anshu Rohatgi, senior consultant neurologist and professor at Sir Gangaram Hospital, was paying a visit to the orthopedician, his colleague, when Shukla ran into him. The orthopedician shared the case history with his friend. A glance at the report, and Dr Rohatgi suspected that the man was suffering from multiple sclerosis (MS), a disease that the family had not even heard about. Tests further confirmed his worst fears.
Today, the businessman is back to leading a life as normal as possible.
Approximately 2.9 million, or 1 in 3,000 people in the world, have multiple sclerosis. In India, approximately 1.5 lakh people (11 per one lakh) are suffering from MS, which is a chronic disease of the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves. This debilitating disease is a leading cause of non-traumatic disability in young people, commonly diagnosed between the ages of 20 and 40, and is twice as likely in women than men. In this progressive disease, patients suffer tremendous disability while the quality of life deteriorates along with regular hospital costs.
Advancements in therapies
Innovative highly effective MS therapies are therefore essential to tackle progression and help reduce the impact of the disease on the daily lives of people with MS and their families, according to experts. According to Dr Vinay Goyal, chairman, neurology, neurosciences, Medanta, Gurugram, there is no cure for MS, but medications known as disease-modifying therapies are available to help reduce the frequency and severity of relapses. He said these therapies, which can be administered orally, via injections, or through infusions, aim to minimise damage and scarring to the myelin sheath surrounding the nerves, commonly associated with MS relapses. Myelin is an insulating layer, or sheath that forms around nerves, including those in the brain and spinal cord. It is made up of protein and fatty substances.
Relapsing or progressive
Most people living with MS either have relapsing-remitting MS (RRMS) or primary progressive MS (PPMS) at the time of diagnosis. RRMS is characterised by episodes of new or worsening symptoms (relapses) followed by recovery periods. PPMS is a highly disabling form of MS characterised by steadily worsening symptoms, usually without periods of improvement/remission. Approximately 15% of people with MS are diagnosed with PPMS. Dr Goyal said there are various treatments - from steroid treatment to symptom special therapies to disease-modifying therapies - that reduce the frequency and severity of MS relapses and slow down disease progression. Dr Rohatgi, who treated Shukla for PPMS, said they started the businessman straight on ocrelizumab - a breakthrough drug that has been approved by USFDA - for it not only enhances the quality of life in MS patients but also promises improved outcomes. “We had to import the drug at that time because it was not yet introduced in India. Now, it is available in India. Until now, there was no treatment option for patients suffering from primary progressive MS.”
“This (the drug) represents a monumental breakthrough, addressing a longstanding unmet need and extending hope to a substantial portion of the MS community in India, covering the majority of MS patients,” he added.
He said with a robust decade-long track record of safety and efficacy, the therapeutic monoclonal antibody has emerged as the preferred choice for MS treatment, offering relief and convenience with its twice-yearly dosing schedule. Monoclonal antibodies are laboratory-produced molecules engineered to serve as substitute antibodies that can restore, enhance, modify or mimic the immune system's attack on cells that aren't wanted. He said the drug helps ease the burden of hospitalisations and promotes adherence. “It not only enhances the quality of life for MS patients but also holds promise for improved outcomes,” he added.
Treatment cost
Ocrelizumab is currently the sole approved therapy for all forms of MS, including PPMS. Over three lakh patients have been treated with Ocrevus across 100 countries. It targets a type of immune cell called CD20-positive
B cell that plays a vital role in the disease. It may be out of reach for many as the drug costs between `10-12 lakh a year, depending on the dosage, in India.
However, Dr Rajasekhar Reddi, Director, Max Institute of Neurosciences, Max Super Speciality Hospital, Saket, Delhi, said the drug stands out with its proven clinical efficacy and real-world evidence. “It's time we prioritise treatments backed by substantial data to provide meaningful relief to those battling this relentless condition."
Diagnosis and management
Echoing the demand for medications that effectively manage the disease, Dr Manoj Satyawani, director and consultant neurologist, Institute of Neurosciences, Surat, Gujarat, said, “Even when clinical symptoms seem stable, all forms of MS entail underlying disease activity, characterised by nervous system inflammation and irreversible brain nerve cell loss. The primary goal in MS treatment is to diminish disease activity, thus decelerating disability progression promptly.”
MS patients face unique challenges on different fronts, which start right from early detection, said Sandeep Chitnis, national honorary secretary, Multiple Sclerosis Society of India. He said the disease-modifying treatment costs lakhs and should be classified under rare diseases. "Timely diagnosis can help prevent the onset of most of the disabilities. An MS patient can live a productive life with the help of the latest treatments at the early stage.” Experts said the first battle won is on detecting MS early. Unfortunately, no one test can be done to diagnose MS, which is a lifelong condition without a cure.
“MS is diagnosed by combining clinical and MRI findings, electric or neurophysiological investigations, and laboratory tests. If these tests fulfil a set of so-called MS diagnostic criteria, the healthcare professional or neurologist diagnoses MS,” added Dr Preetha, consultant neurologist, Prashanth Hospitals, Chennai. Once it is diagnosed, there are treatments aimed at managing symptoms, minimising the frequency of flare-ups, regulating disease progression, and improving quality of life, she added.
