Multiple Sclerosis Medications: How MS Drugs Work [2019 Update]


in this video I’m going to explain to
you how the LS disease-modifying therapies work all of them using simple
language and easy to understand analogies if you’d like to better
understand how these meds work stay tuned because I’ll start explaining
right now howdy thanks for learning about MS with
me Aaron Boster. I started this YouTube channel to help my own MS clinic
patients learn between visits and it’s my hope that through these videos I can
help you learn to today’s topic disease modifying therapies the medicines that
we use to slow or delay multiple sclerosis in 2019 there are literally 17
different FDA formulations of these medicines and they’re weird in the way
that they work because what we’re trying to do is alter the immune response which
is no easy task it’s very easy to get lost and how these medicines work and
over the years I’ve come up with ways of trying to help people understand what
the medicine they take does I’ve made several videos on this channel on each
one of these drugs but I thought I would take a few moments and pull them all
together to give you the highlights of how these meds work using simple
easy-to-understand analogies and everyday language so let’s jump in
number one Copaxone go TL or acetate these are injections they’re one of the
first line medicines and they work by tricking the immune response Copaxone is
four amino acids in a random chain these four amino acids look like a certain
protein specifically they look like myelin the coating on the nerves that
you’re naughty immune system is trying to attack when you take Copaxone you
literally show your immune system its target you say hey look look at this and
then a couple days later you reject hey look at it again and then a couple days
later try to look at it again and you literally keep shoving the target in the
immune systems face and over time the immune system becomes bored when the
immune system later sees the real myelin the real target in the brain it’s a sort
of yesterday happens is instead of launching a
pro-inflammatory raw campaign to try to attack the myelin this is their I saw
that I’m not interested and it moves away
number two interferon beta there are multiple injectable medicines for MS
including trade names such as readeth beta C R on Expedia Avonex plugger II
these medicines work by tightening the blood-brain barrier
the naughty autoreactive cells that will attack you live in the bloodstream and
they cross the blood-brain barrier where they gain access to the brain and spinal
cord the interferon class medicines try to create a better barrier so I think of
the analogy of the Three Little Pigs if the natural blood-brain barrier is the
straw house in the Three Little Pigs analogy when you screw it in a ferrule
on top of it it becomes the stick house it’s a better house so the cells can’t
cross as easily number three a Biagio or tear fluid amide this medicine for MS is
a daily pill and it works differently than the interferons
or Copaxone it works by preventing the cell’s ability to rapidly reproduce when
you have a white blood cell it lives its life and as long as it doesn’t have much
to do it will just plot along and then make a copy of itself before it dies and
then that next I’ll make a copy of itself before it dies and that way you
can maintain the white blood cells which aren’t really do much but if there’s
suddenly a war or a battle that’s about to be fought or your immune system gets
activated that one white blood cell sort of turns on and it will make a bunch of
a bunch of copies which reminds me of the Clone Wars if you’re familiar with
the story of Star Wars where they make a bunch of stormtroopers now when you take
the Biagio it doesn’t kill the cells but it freezes the cells so that they can’t
make multiple copies you can still maintain the style lines it doesn’t kill
them it just prevents them from rapidly reproducing so you can build a bunch of
stormtroopers to go attack your brain when you stop a Biagio that circuitry is
no longer interrupted and now your cells can start to behave more normally number
four dimethyl fumarate or tecfidera this twice of a pill is rather unique in its
mechanism it works by tricking the cells in
thinking that they’re under oxidative stress even though they’re not that
forces themselves to then respond with an antioxidant cascade which slows down
multiple sclerosis a rather unique mechanism of action
number five finger mod or jelenia a once-a-day pill for MS that again has a
rather unique mechanism of action now to understand this I like to set up a brief
analogy think of the white blood cell as a car the blood stream as a road in the
lift mode as a garage car drives down the road enters in the garage now
getting in the garage is free you just go in but leaving a garage requires a
hey tag you have to show you hang tag to exit the garage when you take Junia it
causes us to lose the Hang tag so the car goes down the road and drives into
the garage no big deal but it can’t get out because it doesn’t have a hang tag
as long as you take Junia when the white blood cells in the bloodstream and it
goes into the lymph nodes it becomes trapped it reminds me of that old song
from the Eagles Hotel California even though it anytime you want but you can
never leave as long as you continue to take to linea those cells are
sequestered or trapped in the lift nodes they can’t leave when you stop to linea
then the cell can reexpress his exit hang tag and you can once again leave
the lymphatics that’s how journey works to slow a mess
because if the cells can’t enter in the bloodstream they can’t cross the
blood-brain barrier into the brain so keeping them trapped in the lymph nodes
accomplishes that in a rather unique way number six Tysabri or natalizumab it’s
an infused agent taken once every month and it works to tighten up the
blood-brain barrier in a way that we haven’t seen before remember when I use
the analogy of the Three Little Pigs and I said that the normal blood-brain
barrier is like the straw house when you squirt interferon beta on that it
becomes this thick house when you give someone Tysabri it becomes the brick
house then of course you have to sing “She’s a brick…HOUSE!” Tysabri recreates literally the Great Wall
of China and so that blood-brain barrier is
impermeable and literally cells cannot cross as long as you stay on Tysabri
that Great Wall of China stays intact when you stop Tysabri the Great Wall
goes back to being a straw house number seven
Ocrelizumab, or Ocrevus, it’s a infused drug taking through the vein given twice
a year so every six months and it works in a rather creative way
it kills adult b-cells now allow me to explain think about high school I
remember in high school if two young men bumped into each other in the hallway
there was only one way to settle that dispute they met behind the building at
3:30 and they beat the crap out of each other now I noticed when I would attend
some of these events that young men never showed up to fight by themselves
they always came with six of their very closest friends and those friends would
egg them on go ahead with this but I got you all your bookbag now using this
analogy the t-cell is the cell that’s going to attack your brain spinal cord
but the t-cell can’t do it without stimulation from his friends the b-cells
with okra vus we literally murder all of your friends and so there are no adult
b-cells therefore they can’t get that t-cell riled up to fight and in the
absence of adequate co-stimulation from the B cells that t-cell doesn’t attack
and so why do we give otra vez every six months because six months later you
start to make more b-cells you start to make more friends soon every one of
those guys – and every six months we knock out adult b-cells
which prevents the t-cell from becoming adequately stimulated which prevents it
from attacking you and lastly Allen – slab or limb trata
it’s also in monoclonal antibody infused through IV in the vein and as you recall
it’s taken for five days in a row and then you wait a year and then three days
and then you don’t take it again unless you have new disease activity obviously
this drug works very differently and it’s a style of induction therapy
essentially what you’re doing is you target a
B and T cells and you murder them and then you force the young ones to go back
more well-behaved I like to think of it as a reboot of the immune response so
instead of trying to block a cell you retraining the cell lines to knock it
off so they don’t behave the way they used to there you have it my rendition
of how the MS medicines work using easy-to-understand analogies and
straightforward language my name is Erin Bhaskar and thank you for learning about
ms with me today if you enjoyed this video and think you’d like to see future
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until my next video and take care