Neurology took a decade, and stem cell therapy delayed disability more than some MS drugs

According to a study published in the December 21, 2022 issue of the online journal Neurology, hematopoietic stem cell transplantation may delay disability longer
than some other MS drugs in patients with active secondary progressive multiple sclerosis (MS).
The study involved an autologous hematopoietic stem cell transplant, which uses healthy blood stem cells from the body's own to replace diseased cells
.

While most patients with MS are initially diagnosed with relapsing-remitting MS, characterized by a sudden onset of symptoms followed by a period of remission, many patients with relapsing-remitting MS eventually transition to secondary progressive MS, where symptoms do not fluctuate widely but worsen slowly, steadily
.

Study author Matilde Inglese, MD, University of Genoa, Italy, and a member of the American Academy of Neurology, said: "Hematopoietic stem cell transplantation has previously been found to delay disability in patients with relapsing-remitting MS, but it is unclear whether this transplantation helps delay disability
at a later stage of the disease.
Our results are encouraging because, while there is currently modest or small benefit in the treatment of secondary progressive multiple sclerosis, our study found that stem cell transplantation may not only delay disability over many other multiple sclerosis drugs, but may also have a slight improvement
in symptoms.
”

The retrospective study included 79 patients with active secondary progressive multiple sclerosis who underwent stem cell transplantation and 1975 patients
receiving multiple sclerosis drugs from the Italian Multiple Sclerosis Registry.
All patients were treated
after a diagnosis of active secondary progressive multiple sclerosis.
The ages, sexes, and degrees of disability matched
between the two groups.
Drugs include interferon, azathioprine, glatiremo acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, terflunomide, cyclophosphamide, dimethyl fumarate, and alentuzumab
.

The participants' levels of disability were measured using the Extended Disability Status Scale, a common way to quantify disability, with scores ranging from 0, asymptomatic, to 10, with MS causing death
.
Participants were assessed
at various time points over a 10-year period.

At the start of the study, participants who received both transplants and those treated with the drug had median scores of 6.
5
.
A score of 6.
0 is defined as the need to walk about 100 meters intermittently using crutches or supports or one side, with or without rest
.
A score of 6.
5 is defined as the need to constantly use crutches or supports on both sides to walk about 20 meters without rest
.
After five years of the study, researchers found that 62 percent of stem cell transplant patients had multiple sclerosis disability that did not worsen, compared with 46 percent
of patients taking medication.
In addition, over the 5-year study, the researchers found that people who received stem cell transplants were more likely to see sustained improvement over time, with 19 percent having fewer disabilities than at the start of the study, compared with just 4 percent
of those taking medication.

Over 10 years, disability scores for people who received stem cell transplants decreased by an average of 0.
01 points per year, meaning fewer disabilities, while the average rating of people treated with drugs increased by 0.
16 points per year, with an increase
in disability.

Inglese said: "Our study shows that hematopoietic stem cell transplantation is associated with
a higher likelihood of slowing disability progression and improving disability compared to other therapies.
While these results are encouraging, they do not apply to patients with secondary progressive MS who have no signs of inflammatory activity; We need more studies in larger populations to confirm our findings
.
”

The limitation of this study is that it is retrospective and observational, and does not prove cause and effect
.
It indicates only one association
.
The study did not include people taking these MS drugs: siponimod, cladribine, ocrelizumab, ofatumumab or rituximab
.

The study was funded
by the Italian Multiple Sclerosis Foundation.