Selected Podcast
New and Expanding Options for MS Treatment
With many treatments available for multiple sclerosis, our experts provide personalized care plans for our patients who receive top-notch and innovative care at The Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital.
Featured Speaker:
Christopher Langston, MD
Christopher Langston, M.D. completed his Fellowship in Multiple Sclerosis and his Residency as Chief Resident in Neurology at Icahn School of Medicine at Mount Sinai Hospital in New York, NY. He completed his Internal Medicine internship at Albert Einstein College of Medicine at Jacobi Medical Center in Bronx, New York. Dr. Langston earned his PhD in biomedical ethics from the University of Toronto in Ontario, ON and his medical doctorate from the University of Massachusetts Medical School in Worcester, MA. Dr. Langston is an avid clinical researcher of current and advanced topics in multiple sclerosis management and patient-centered care.Transcription:
Prakash Chandran: Today, there are a variety of treatment options for people with multiple sclerosis. Sometimes the choices can seem overwhelming, but it's important for patients to be treated at a facility where doctors know all the treatments and can help the patient choose the one that's right for them. We're going to talk about it today with Dr. Christopher Langston, an Assistant Professor of Neurology at the Albert Einstein College of Medicine in the Bronx and the Medical Director of the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital. This is Health Track, the podcast from Montefiore Nyack Hospital. I'm Prakash Chandran.
So first of all, Dr. Langston, it is great to have you here today. Let's just start with a basic question of what exactly is multiple sclerosis.
Dr. Christopher Langston: Thank you for having me. Multiple sclerosis is a disease of the central nervous system where the immune system gets basically deranged. And instead of attacking foreign invaders like bacteria and viruses and funguses, instead attacks the parts of the brain and spinal cord.
Prakash Chandran: So how do those symptoms manifest in someone with MS? Do they, for example, lose the ability to use certain parts of their body? Maybe talk about some of the symptoms that someone might experience.
Dr. Christopher Langston: Right. The multiple part of multiple sclerosis is multiple times in multiple places in the central nervous system. And because it can happen anywhere in the central nervous system, it can produce any symptoms affecting any kind of system. So it can affect your vision. It can affect your sense of smell, sense of taste. It can affect their sensation, so you can get numbness, tingling, burning, sort of strange feelings in different parts of your body. It can affect your ability to urinate, to pass bowel movements. It can affect your ability to walk, weakness, your ability to coordinate movement. So various systems within the central nervous system can be affected and it's different for each patient.
Prakash Chandran: Got it. And what do we understand about what causes multiple sclerosis and who is at the highest risk of getting it?
Dr. Christopher Langston: It's a disease that primarily affects women more than men at a rate of about three women for every man. And it's typically women in their younger years so in their twenties, thirties, and forties. When it does affect men, it typically affects them a little bit later in life. And it does affect children sometimes but rarely.
Prakash Chandran: So we talked about some of the things that someone might experience if they have MS. You said that it doesn't really show up in children that often. So I'm assuming that later on in life, they start to experience a couple symptoms that are worrisome. Talk a little bit about how it's diagnosed.
Dr. Christopher Langston: Well, usually, people come to their doctor's attention because they come in complaining of some symptoms they're not sure what to make of. They have a numb arm or wake up with a numb leg. They can't see out of one eye. They're having unexplained urinary frequency. Whenever they’ve been running and towards the end of their run, they start dragging or tripping a leg. Things like that.
And then they'll go to their doctor. They oftentimes get various kinds of other workups, depending on whichever organ system seems to primarily and be involved. They'll go to their eye doctors. They'll go to the orthopedist. They'll go to the urologist, something like that. And in the course of that workup, they might discover that it's not related directly to the eye or the bladder, or to the muscles and bones, but instead the nerves that subserve that system. And so then they end up getting referred to a neurologist, getting MRIs primarily, which is the main diagnostic biomarker that we use.
And then also we sometimes do some additional testing, including things like lumbar punctures to look at the cerebral spinal fluid, to see if there's any signs of inflammation there. Looking at the conduction of the nerves, sometimes of the eyes, things like that.
Prakash Chandran: Okay. So if someone comes to you and it has been determined that they have MS, what are the most common treatment options that are available to them?
Dr. Christopher Langston: So one of the things about treating MS, is there are some subtypes which we have learned about that help us guide management a little bit, and part of the next phase of MS treatment is going to be trying to find treatment options that are really tailored to the individual patient. We're sort of blessed right now in that we have something on the order of more than 20 different medicines for MS that are even approved plus many off-label treatments. And there are more coming out every year.
There's a lot of variety of criteria that go into helping a patient decide what treatment is best for them. One of them is efficacy. We want treatments that work really well. Another is safety. We want to minimize side effects. And the other is tolerability. These medicines come in different kinds of ways that impact different people's lifestyles. So some are pills, some are injections, some are infusions. And it really depends on how the patient lives their life and what's going to work best for them.
Prakash Chandran: And before we go further, I think something we should recognize or a question that I have is there is no cure for multiple sclerosis, is there?
Dr. Christopher Langston: There's not a cure. The primary form of multiple sclerosis is relapsing-remitting. And some people rarely go into remission and their disease never returns in any symptomatic way. And that's our goal with treatment, is to put people into permanent remission. But there isn't anything that we could really call a cure. Though there is a question about what exactly is a cure with a chronic disease like MS.
The most common treatments that people prefer these days are generally pills that you can take or infusions that you can get in in a hospital setting, just because they're the most convenient. But for some patients because of their lifestyle or because of their concerned about certain kinds of safety issues, they opt for self injections, which they can take with them anywhere.
Prakash Chandran: Got it. So when we talk about the different treatment options you know, you talked about the different treatment modalities that were available on a case by case basis, but maybe talk about some of the new ones that have come onto the market and what the benefits of using them might be.
Dr. Christopher Langston: Sure. Well, there's a lot of second generation drugs coming out right now, which have better safety profiles but similar efficacy to older medicines. And so that's always a benefit. One of those that came out recently is a medicine called Vumerity, which is sort of next generation version of an older medicine called Tecfidera. And this newer version has fewer GI side effects, so people tolerate it much better.
The best thing is efficacy. I mean, some of our treatments now are much more efficacious than the older treatments. They often aren't compared head to head. So these have to be inferred by various kinds of observational studies. The data is a little bit softer than what you find in clinical studies that comes from FDA approval of a medicine, but in general, the newer medicines are much more efficacious and with every passing generation, more safe for patients.
The more exciting things that are coming out are medicines that hopefully will help patients avoid some of the long-term side effects of MS. So often a common thing that happens with MS patients is they have an early relapsing-remitting phase, which then later in the illness becomes slowly progressive. So instead of having a new symptom that then gets better, they get slowly worse year by year in small little ways.
There's a couple of mechanisms that could be accounting for that. One of them could be related to the immune system. And so we've had some new promise of some new drugs. Hopefully, they will be approved later this year. They have already been approved for other kinds of conditions, especially certain kinds of blood cancers. And these are called BTK inhibitors and they hold out some promise for being able to give progressive patients who are not having relapses a new treatment option. We are waiting hopefully FDA approval of those later this year in 2021.
Prakash Chandran: So just as we close here, I know a question that might be on a lot of people's minds is are they able to live a normal full life with MS, especially with a lot of these new treatment options that we're talking about today?
Dr. Christopher Langston: Yes, absolutely. I mean, that's our goal, is to make every patient be able to live a full life as if they didn't have MS. And in fact, you know, sometimes we overshoot and patients almost start missing appointments and things because they feel like they're in full remission and things are going very well for them.
The other part of it is not just maintaining health, but also being able to live full lives because what you find a lot of patients are concerned about is "Can I have children?" "Is this going to impact the ability I have to work, to take care of my kids, to continue to do the things I love to ski, to run, to get outside, to socialize with my friends?" Those are the things that they really care about, and those are the things that we're really trying to do our best to protect patients from having any compromise of that, of their ability to live their lives. So in that sense, we've had really leaps forward in the last 20 years in our ability to treat MS.
In terms of their general health, the other things that MS patients really always need to have is a primary care physician. They always have an MS neurologist, which is important, but having a primary care physician who can help troubleshoot a lot of small things that come up, infections or other things, is also a really important thing. And keeping on top of your general health, in addition to your neurological health is really important for all MS patients.
Prakash Chandran: Well, Dr. Langston, that is very good advice and I think a perfect place to end. Thank you so much for your time today. That's Dr. Christopher Langston, an Assistant Professor of neurology at the Albert Einstein College of Medicine in the Bronx and the Medical Director of the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital.
For more information about the services provided at the center, call (845) 348-8880 or visit MontefioreNyack.org/multiple-sclerosis. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Health Track, the podcast from Montefiore Nyack Hospital. Thanks so much and we'll talk next time.
Prakash Chandran: Today, there are a variety of treatment options for people with multiple sclerosis. Sometimes the choices can seem overwhelming, but it's important for patients to be treated at a facility where doctors know all the treatments and can help the patient choose the one that's right for them. We're going to talk about it today with Dr. Christopher Langston, an Assistant Professor of Neurology at the Albert Einstein College of Medicine in the Bronx and the Medical Director of the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital. This is Health Track, the podcast from Montefiore Nyack Hospital. I'm Prakash Chandran.
So first of all, Dr. Langston, it is great to have you here today. Let's just start with a basic question of what exactly is multiple sclerosis.
Dr. Christopher Langston: Thank you for having me. Multiple sclerosis is a disease of the central nervous system where the immune system gets basically deranged. And instead of attacking foreign invaders like bacteria and viruses and funguses, instead attacks the parts of the brain and spinal cord.
Prakash Chandran: So how do those symptoms manifest in someone with MS? Do they, for example, lose the ability to use certain parts of their body? Maybe talk about some of the symptoms that someone might experience.
Dr. Christopher Langston: Right. The multiple part of multiple sclerosis is multiple times in multiple places in the central nervous system. And because it can happen anywhere in the central nervous system, it can produce any symptoms affecting any kind of system. So it can affect your vision. It can affect your sense of smell, sense of taste. It can affect their sensation, so you can get numbness, tingling, burning, sort of strange feelings in different parts of your body. It can affect your ability to urinate, to pass bowel movements. It can affect your ability to walk, weakness, your ability to coordinate movement. So various systems within the central nervous system can be affected and it's different for each patient.
Prakash Chandran: Got it. And what do we understand about what causes multiple sclerosis and who is at the highest risk of getting it?
Dr. Christopher Langston: It's a disease that primarily affects women more than men at a rate of about three women for every man. And it's typically women in their younger years so in their twenties, thirties, and forties. When it does affect men, it typically affects them a little bit later in life. And it does affect children sometimes but rarely.
Prakash Chandran: So we talked about some of the things that someone might experience if they have MS. You said that it doesn't really show up in children that often. So I'm assuming that later on in life, they start to experience a couple symptoms that are worrisome. Talk a little bit about how it's diagnosed.
Dr. Christopher Langston: Well, usually, people come to their doctor's attention because they come in complaining of some symptoms they're not sure what to make of. They have a numb arm or wake up with a numb leg. They can't see out of one eye. They're having unexplained urinary frequency. Whenever they’ve been running and towards the end of their run, they start dragging or tripping a leg. Things like that.
And then they'll go to their doctor. They oftentimes get various kinds of other workups, depending on whichever organ system seems to primarily and be involved. They'll go to their eye doctors. They'll go to the orthopedist. They'll go to the urologist, something like that. And in the course of that workup, they might discover that it's not related directly to the eye or the bladder, or to the muscles and bones, but instead the nerves that subserve that system. And so then they end up getting referred to a neurologist, getting MRIs primarily, which is the main diagnostic biomarker that we use.
And then also we sometimes do some additional testing, including things like lumbar punctures to look at the cerebral spinal fluid, to see if there's any signs of inflammation there. Looking at the conduction of the nerves, sometimes of the eyes, things like that.
Prakash Chandran: Okay. So if someone comes to you and it has been determined that they have MS, what are the most common treatment options that are available to them?
Dr. Christopher Langston: So one of the things about treating MS, is there are some subtypes which we have learned about that help us guide management a little bit, and part of the next phase of MS treatment is going to be trying to find treatment options that are really tailored to the individual patient. We're sort of blessed right now in that we have something on the order of more than 20 different medicines for MS that are even approved plus many off-label treatments. And there are more coming out every year.
There's a lot of variety of criteria that go into helping a patient decide what treatment is best for them. One of them is efficacy. We want treatments that work really well. Another is safety. We want to minimize side effects. And the other is tolerability. These medicines come in different kinds of ways that impact different people's lifestyles. So some are pills, some are injections, some are infusions. And it really depends on how the patient lives their life and what's going to work best for them.
Prakash Chandran: And before we go further, I think something we should recognize or a question that I have is there is no cure for multiple sclerosis, is there?
Dr. Christopher Langston: There's not a cure. The primary form of multiple sclerosis is relapsing-remitting. And some people rarely go into remission and their disease never returns in any symptomatic way. And that's our goal with treatment, is to put people into permanent remission. But there isn't anything that we could really call a cure. Though there is a question about what exactly is a cure with a chronic disease like MS.
The most common treatments that people prefer these days are generally pills that you can take or infusions that you can get in in a hospital setting, just because they're the most convenient. But for some patients because of their lifestyle or because of their concerned about certain kinds of safety issues, they opt for self injections, which they can take with them anywhere.
Prakash Chandran: Got it. So when we talk about the different treatment options you know, you talked about the different treatment modalities that were available on a case by case basis, but maybe talk about some of the new ones that have come onto the market and what the benefits of using them might be.
Dr. Christopher Langston: Sure. Well, there's a lot of second generation drugs coming out right now, which have better safety profiles but similar efficacy to older medicines. And so that's always a benefit. One of those that came out recently is a medicine called Vumerity, which is sort of next generation version of an older medicine called Tecfidera. And this newer version has fewer GI side effects, so people tolerate it much better.
The best thing is efficacy. I mean, some of our treatments now are much more efficacious than the older treatments. They often aren't compared head to head. So these have to be inferred by various kinds of observational studies. The data is a little bit softer than what you find in clinical studies that comes from FDA approval of a medicine, but in general, the newer medicines are much more efficacious and with every passing generation, more safe for patients.
The more exciting things that are coming out are medicines that hopefully will help patients avoid some of the long-term side effects of MS. So often a common thing that happens with MS patients is they have an early relapsing-remitting phase, which then later in the illness becomes slowly progressive. So instead of having a new symptom that then gets better, they get slowly worse year by year in small little ways.
There's a couple of mechanisms that could be accounting for that. One of them could be related to the immune system. And so we've had some new promise of some new drugs. Hopefully, they will be approved later this year. They have already been approved for other kinds of conditions, especially certain kinds of blood cancers. And these are called BTK inhibitors and they hold out some promise for being able to give progressive patients who are not having relapses a new treatment option. We are waiting hopefully FDA approval of those later this year in 2021.
Prakash Chandran: So just as we close here, I know a question that might be on a lot of people's minds is are they able to live a normal full life with MS, especially with a lot of these new treatment options that we're talking about today?
Dr. Christopher Langston: Yes, absolutely. I mean, that's our goal, is to make every patient be able to live a full life as if they didn't have MS. And in fact, you know, sometimes we overshoot and patients almost start missing appointments and things because they feel like they're in full remission and things are going very well for them.
The other part of it is not just maintaining health, but also being able to live full lives because what you find a lot of patients are concerned about is "Can I have children?" "Is this going to impact the ability I have to work, to take care of my kids, to continue to do the things I love to ski, to run, to get outside, to socialize with my friends?" Those are the things that they really care about, and those are the things that we're really trying to do our best to protect patients from having any compromise of that, of their ability to live their lives. So in that sense, we've had really leaps forward in the last 20 years in our ability to treat MS.
In terms of their general health, the other things that MS patients really always need to have is a primary care physician. They always have an MS neurologist, which is important, but having a primary care physician who can help troubleshoot a lot of small things that come up, infections or other things, is also a really important thing. And keeping on top of your general health, in addition to your neurological health is really important for all MS patients.
Prakash Chandran: Well, Dr. Langston, that is very good advice and I think a perfect place to end. Thank you so much for your time today. That's Dr. Christopher Langston, an Assistant Professor of neurology at the Albert Einstein College of Medicine in the Bronx and the Medical Director of the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital.
For more information about the services provided at the center, call (845) 348-8880 or visit MontefioreNyack.org/multiple-sclerosis. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Health Track, the podcast from Montefiore Nyack Hospital. Thanks so much and we'll talk next time.
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