Question: Will “newer” medications with “higher average efficacy” necessarily have a better effect on everyone compared to older medications, or is it more about averages and individual responses? Is the effect of a medication the same when used at the onset of the disease versus later stages?

Answer:
The term “higher average efficacy” refers to the average effectiveness of the medication in a specific population studied. Individual responses vary, and some people may respond well to medications with moderate efficacy, while others might not respond sufficiently even to those with high efficacy.

The earlier treatment is initiated during the disease, the better the chance of achieving greater effectiveness and higher overall efficacy.

Question: Is there a medication for progressive multiple sclerosis (MS)?

Answer:
For primary progressive MS (PPMS), the only approved medication that has demonstrated efficacy is Ocrelizumab (Ocrevus).

Most other medications available for relapsing MS may also be somewhat effective for secondary progressive MS (SPMS), especially in younger patients whose disease remains active (with relapses, new lesions, or enhancing lesions on MRI).

Question: Is hyperbaric oxygen therapy recommended for progressive MS? Is there a treatment to regenerate myelin? Should biological therapies like Ocrevus be switched after a certain treatment duration?

Answer:

• Hyperbaric oxygen therapy: There is no evidence supporting its efficacy for progressive MS, and it is therefore not recommended.
• Myelin regeneration:
  There are no approved treatments for myelin regeneration yet. However, several drugs are in early or late research stages with potential remyelination (myelin renewal) or myelin creation abilities, including:

• • Clemastine, Ibudilast, Opicinumab (which failed clinical trials), thyroid hormones, and others.
  • Existing MS drugs such as Gilenya, Mayzent, Zeposia, Mavenclad, Lemtrada, and Ocrevus have shown limited evidence of promoting myelin repair.
  • Drugs used for other conditions, like Metformin (a diabetes medication) and Miconazole (an antifungal), have also demonstrated potential in laboratory studies.

However, it remains unclear whether the level of myelin repair observed in labs or animal studies would translate to meaningful clinical improvements in MS patients. Many promising treatments have failed in clinical trials.

Stem cell transplants may also replenish the brain’s pool of myelin-producing cells, though this treatment is still experimental.

• Switching biological therapies:
  Duration of treatment alone is not a reason to switch therapies like Ocrevus. Reasons to change include insufficient clinical effectiveness, intolerable side effects, or increased treatment risk (e.g., JC virus antibodies when using Tysabri).

Question: I’m 67 and have never been vaccinated. What is your opinion on the flu vaccine?

Answer:
The flu vaccine is recommended for everyone aged 67, particularly for those with MS. The vaccine can prevent flu infections, which might trigger relapses or worsen existing MS symptoms.

Question: Are there studies on drugs to repair the myelin sheath, and have any received FDA approval?

Answer:
No drugs for myelin regeneration have yet received FDA approval.
(See the answer to Question 3 for detailed information about ongoing research and experimental treatments for myelin repair.)