Foralumab Nasal Spray May Offer New Hope for MS Treatment

A new nasal spray treatment called foralumab may offer hope for those living with multiple sclerosis (MS). Mass General Brigham researchers recently completed a phase 1 clinical trial of foralumab, which shows promise in reducing MS symptoms and improving the quality of life for those affected by this condition.

“Our research into this new nasal antibody treatment represents a significant step forward in managing MS symptoms,” says Tanuja Chitnis, MD, FAAN, director of the Translational Neuroimmunology Research Center at Mass General Brigham. “It has the potential to improve the lives of many patients by reducing inflammation and enhancing physical function.”

Dr. Chitnis, who also serves as the director of the Mass General Brigham Pediatric MS Center and Co-Director of the Brigham and Women’s Hospital MS Center, has dedicated her career to helping patients with MS at every stage of life. She is at the forefront of groundbreaking research on new treatments.

What is MS and how could foralumab help?

MS is a neurological condition that makes the immune system attack the brain, spinal cord, and optic nerves. This causes damage to myelin, the protective layer around nerve fibers, which leads to disrupted communication between the brain and the rest of the body. Over time, this damage can worsen and may cause serious physical and neurological problems.

MS typically develops between the ages of 20 and 40 and affects women more often than men. The course of the disease varies, but it often involves periods of worsening followed by partial recovery, or in some cases, a steady decline in function.

Mass General Brigham researchers are studying foralumab, a nasal spray that targets the immune system to help protect nerves and slow down disease progression. Dr. Chitnis and her team are testing foralumab’s effectiveness in treating secondary progressive multiple sclerosis (SPMS), a more advanced stage of MS where symptoms worsen continuously without remission.

Foralumab is a type of monoclonal antibody, which is a lab-created protein designed to replicate the immune system’s ability to fight off harmful cells. Monoclonal antibodies have been successfully used to treat conditions like cancer and migraines. Researchers are also studying how foralumab may help manage other inflammation-driven diseases, including COVID-19 and Alzheimer’s disease, by reducing inflammation and protecting nerve cells.

Early results of foralumab nasal spray trial

Dr. Chitnis and team found that foralumab helped:

• Reduce fatigue and improve physical function. People with MS who took foralumab experienced less fatigue and better physical function, which made it easier to carry out daily activities.
• Improve daily activities. Patients using the nasal spray reported improvements in daily tasks, such as walking and using their hands, which are often affected by MS.
• Reduce inflammation. The treatment also showed potential in lowering overall inflammation, a common issue in many neurological diseases.

These early results fuel the hope that foralumab could offer continued symptom relief and protection against the progressive damage caused by MS.

How may foralumab help manage MS symptoms?

In the later stages of MS, like SPMS, symptoms often worsen steadily, making everyday tasks harder to manage. Foralumab may help control symptoms, particularly for those experiencing a steady decline in mobility and balance.

Knowing the early signs of MS can help you know when to talk to your health care provider. The sooner you get a diagnosis, the sooner you can get care to manage the disease better over time.

Early MS signs and symptoms

These include:

• Trouble walking
• Feeling tired
• Muscle weakness or spasms
• Blurred or double vision
• Numbness and tingling
• Sexual problems
• Poor bladder or bowel control
• Pain
• Depression
• Problems focusing or remembering

Signs and symptoms of MS relapses

These include:

• Numbness, tingling, or weakness in the arms and legs, often on one side of the body
• Memory and mood changes
• Trouble thinking and concentrating
• Balance problems, vertigo, and trouble walking
• Bladder and bowel problems
• Vision changes, including double vision or loss of vision

These symptoms can vary in severity and may come and go, but managing them early can help improve quality of life for people with MS.

How is MS diagnosed?

There is no single test to diagnose MS. Doctors confirm MS based on signs and symptoms that develop in different parts of the nervous system at different times, and after ruling out other diagnoses.

The following tests help confirm the diagnosis:

• MRI scans. Doctors use MRI scans of the brain and spinal cord to detect lesions typical of MS. They may use a special dye to highlight active lesions.
• Lumbar puncture. Also known as a spinal tap, this test examines cerebrospinal fluid to find proteins and inflammatory cells associated with MS. It also helps exclude other conditions.
• Evoked potential tests. These tests use electrodes on the skin to measure how quickly and accurately the nervous system responds to stimuli.
• Blood tests. Doctors conduct blood tests to rule out other conditions that cause symptoms similar to MS.

These tests, combined with a complete medical history, physical exam, and detailed neurological exam, help doctors diagnose MS.

What are current treatments for MS?

Treating MS is challenging because symptoms vary between patients and flare-ups are unpredictable. While there is no cure, there are treatments that can reduce the number of relapses.

Current treatments include:

• Medications. Drugs that target certain immune cells can decrease the number of relapses. Other medications, like muscle relaxers and antidepressants, can help reduce symptoms.
• Stem cell therapy. This treatment involves removing, treating, and replacing your own cells to reset your immune system, helping those with frequent relapses.
• Physical therapy and exercise. These can improve movement and reduce stress.
• Nutrition counseling. Healthy eating can improve overall health.
• Psychiatric counseling. Some patients find speaking with a mental health care provider can help them manage the impact of MS on their daily life.

Current treatments help with relapses, but foralumab could be a new option for patients with SPMS when other treatments don’t work. Right now, there are no FDA-approved treatments for non-active SPMS. However, Mass General Brigham researchers are leading a new study to see if foralumab can help. This study may lead to better ways to manage symptoms in the later stages of MS, where options are limited. Research like this at Mass General Brigham is what is helping move MS care forward.

Mass General Brigham research to advance MS care

Foralumab is just one of the promising treatments being studied at Mass General Brigham to help people with MS. Researchers at Massachusetts General Hospital and Brigham and Women’s Hospital are also conducting innovative research and studies to learn more about MS and find better treatments. These include:

• Advanced imaging technology: Scientists at Massachusetts General Hospital are using advanced scanners like the Connectome 2.0 and new MRI techniques to take detailed pictures of the brain. These images help them see how MS damages the brain and affects memory and movement. This could lead to better ways to treat MS.
• MRI study on axon damage: Mass General Brigham researchers are studying axon damage in MS, which can affect thinking and movement. Their research plays a key role in finding better ways to monitor and treat MS.
• Wearable device study: Brigham and Women’s Hospital researchers are testing a smart insole that monitors MS symptoms, such as gait and balance, right at home. This device could help doctors detect changes in symptoms earlier.
• Precision medicine and biomarkers: Researchers at Brigham and Women’s Hospital are working on ways to better match MS treatments to each person. They are studying certain genes, proteins, and other markers in the body that could help doctors predict how the disease will progress and which treatments will work best. This research could help create more personalized care for people with MS.

With ongoing research and promising new treatments like foralumab, there is hope on the horizon for those living with multiple sclerosis.