A new experimental drug is giving hope for people living with advanced multiple sclerosis (MS), particularly those with non-relapsing secondary progressive MS (SPMS), a harsh form of the disease marked by worsening neurological function and increasing disability over time. The results of the study, published in the New England Journal of Medicine, revealed that an experimental drug, tolebrutinib, showed a strong ability to reduce the progression of disability of MS
The lead researcher, Dr. Robert Fox, a neurologist at the Cleveland Clinic’s Mellen Center for MS Research and Treatment, highlighted the study results. “This is the first clinical trial showing a positive effect in delaying disability progression in non-relapsing SPMS,” he stated in a news release, mentioning the lack of approved treatments for this specific form of MS.
The clinical trial for this drug had over 1,100 participants ages 18-60 across 31 countries. These people, all diagnosed with MS, were received either tolebrutinib daily by mouth or a placebo. The results were encouraging, showing a 31% reduction in the progression of MS-related disability among those receiving tolebrutinib compared to the placebo group after six months.
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Tolebrutinib showed other benefits as well. The study showed that nearly twice as many patients taking tolebrutinib saws improvements in their disability compared to those taking the placebo (8.6% versus 4.5%).
Tolebrutinib is in a class of drugs called tyrosine kinase inhibitors, made for the treatment of lymphomas and blood diseases. These drugs disable enzymes that promote cell growth and division. Regarding MS, tolebrutinib may work by reducing brain and spinal cord inflammation, a key factor in worsening MS. Dr. Fox suggested that tolebrutinib could be a potential “new class of medications for the treatment of MS, the leading cause of non-traumatic disability in young adults.”
However, the study also had a possible safety concern—increased risk of liver injury. Elevated levels of a liver injury-indicating enzyme were found in 4 percent of those taking tolebrutinib compared to 1.6 percent of those taking the placebo.
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The Potential Benefits for Black Americans with MS
This clinical trial was diverse by including multiple countries, but it’s to consider how this drug, if approved, works for Black people with MS. Black people often deal with MS differently, sometimes with an earlier onset, more rapid progression, and a greater burden of disability. They may also face disparities in access to diagnosis and treatment.
A drug like tolebrutinib could be impactful for Black Americans with SPMS. By potentially slowing down the accumulation of neurological damage, tolebrutinib could contribute to:
- Improved long-term functional outcomes: Delaying disability progression could mean better mobility, cognitive function, and overall independence for a longer period.
- Enhanced quality of life: By managing the impact of the disease on daily life, tolebrutinib could lead to a better quality of life for Black individuals living with SPMS and their families.
- Addressing disparities in disease course: If Black Americans with SPMS tend to experience more rapid progression, a drug that effectively slows this progression could help to reduce the burden of disease.
However, current clinical trial data may not reflect the experiences and outcomes of Black people with MS.
The Critical Importance of Clinical Trials and Diverse Participation
The encouraging results of this clinical trial show just how important clinical research in advancing the understanding and treatment of diseases like MS.
For a drug like tolebrutinib to work for SPMS, including in Black folks, diverse representation in clinical trials is key. Here’s why:
- Understanding how diseases look and react in different people: Genetic and environmental factors can influence how MS appears and how different people respond to treatment. Including diverse populations in trials helps researchers better understand drug safety and effectiveness.
- Addressing health disparities: Missing minorities in clinical trials has contributed to ongoing health disparities. We need to make sure healthcare is safe and effective for everyone.
- Building trust and improving access: When communities see themselves reflected in clinical research, it can improve trust in the medical system and encourage participation in future studies.
Moving forward, it will be essential for researchers and pharmaceutical companies to actively engage with Black communities and other underrepresented groups to ensure their meaningful participation in MS clinical trials. This includes addressing barriers to participation, such as lack of awareness, transportation issues, and concerns about historical mistreatment in research.
