Looking ahead

David Yeandle is one of the approximately 2.3 million people worldwide with multiple sclerosis (MS). He has found his own way of living with this disease.

“To get what you want, you sometimes have to get your hands dirty,” says Yeandle, with a grin. He is aware that this turn of phrase sounds like something out of a mafia movie, but this 63-year-old looks nothing like a godfather. Quite the opposite, in fact. A personable man living near the port city of Southampton in the United Kingdom, Yeandle uses this ambiguous saying to describe his personal approach to managing his disease – multiple sclerosis (MS). “As a boy, I spent a great deal of time helping out on my grandfather’s farm, and to this very day I still love gardening. With this metaphor, I mean to say that in nature as in life, with MS you must invest time and energy in order to achieve results,” explains Yeandle. He first started having symptoms of the disease around ten years ago. At the time, Yeandle was working as the head of employment policy for an organization representing the UK manufacturing industry to government. Driven by a passion for his job, he worked long hours under tight deadlines and traveled in Europe fairly extensively. “Even though I was used to rushing around, I suddenly started tripping more and more frequently over the pavement. The toes of my shoes were getting really scuffed,” recalls Yeandle. It wasn’t until he’d fallen over a few times getting on and off the London Underground that he decided to seek medical advice. The doctor told Yeandle that he probably had MS. “In some ways, it was almost a relief to hear that,” he comments. “At least it wasn’t a brain tumor, and I already knew something about MS. You see, my sister had been diagnosed with MS more than 30 years before.” A variety of tests were required to get a thorough diagnosis. However, this was during the Christmas period, so it took a few months for the results to come back. “There was this uncertainty looming over everything. It took a real effort on my part to do anything. Even getting up and down the stairs after another relapse was sometimes a real struggle,” recalls Yeandle.

Multiple sclerosis (MS) is a chronic inflammatory disease that attacks the myelin sheath of the central nervous system.

However, when his diagnosis of relapsing-remitting MS was eventually confirmed, he looked to the future and found new energy. Yeandle looked at his condition as a challenge, so he was, as the saying goes, prepared to get his hands dirty. He learned as much as he could about MS; he attended a patient workshop and was pleasantly surprised at the variety of treatment options available. His doctor prescribed Rebif® from Merck , which he self-injects three times a week. He had no problem with the injection process itself. “At first, I was injecting myself in the evening, which caused me to experience mild flu-like symptoms. Then my MS nurse suggested that I change to injecting in the morning, and these side effects have largely disappeared,” recalls Yeandle. The medicine does its job, and his condition has remained stable with no further relapses. Yet he soon wondered whether he would be able to continue his stressful job despite having MS. “My manager was very understanding of my situation, but when on the job, it’s difficult to overcome the sudden fatigue that typically occurs with MS,” explains Yeandle. “Indeed, I often found that I was so shattered on Friday evenings that I wasn’t able to do very much at the weekend.” After nine months, Yeandle took a hard look at the situation and decided to retire early. For the first several months, he enjoyed the peace and quiet. “But I believe that in life, like in gardening, doing nothing contributes to the growth of weeds,” he says, laughing. So he has now found new roles that give him a sense of fulfillment, such as advising multinational companies on employment issues and consulting for the United Nations. Through these pursuits, Yeandle has remained very active and busy for several years, but nowhere near the rapid pace he kept up before developing MS. “These days, I’m somewhat more relaxed about everything and try to pace myself with regular breaks, which is good for me. Because I’ve learned that to live a productive life with MS, you must tend your body in the same way that you tend a garden.”

“To get what you want, you sometimes have to get your hands dirty.”

David Yeandle

Inhibiting inflammation

Merck has many years of experience with drug treatments for autoimmune diseases such as multiple sclerosis (MS) – and also has new therapies in the pipeline. Multiple sclerosis is a chronic inflammatory disease of the central nervous system. It frequently impacts young adults, but can also occur in later adulthood. Women develop the condition about twice as often as men. Frequent symptoms include visual disturbances, numbness or a tingling sensation in the extremities, muscle weakness, and difficulties with coordination. The progression of the disease is unpredictable. The most common type is relapsing-remitting MS, which is characterized by episodic symptoms that disappear either at random or as a result of treatment. In around half of patients with relapsing MS, their condition ends up transitioning to a progressive form of the disease. To this day, the causes of the disease have not been fully clarified. The disease process consists of an autoimmune response against the nerves in the body, which means that inflammatory and immune cells mistakenly attack the body’s own structures. No cure has yet been found for MS, but drugs can be used to treat it. With Rebif® (interferon beta-1a), Merck offers a disease-modifying drug for the treatment of relapsing forms of MS. Rebif® has been proven to reduce disease progression and relapse rates, as well as the expansion and activity of lesions as detected by magnetic resonance imaging. The treatment was approved in Europe in 1998 and in the United States in 2002; it is now registered in more than 90 countries worldwide. In January 2012, the European Commission approved the extension of the indication of Rebif® in early multiple sclerosis. ‟In MS, while there are therapies available, we know there are still opportunities for improvement in terms of efficacy, dosing and response duration, as well as safety and patient quality of life. And we hope to achieve an

Worldwide, around 2.3 million people have multiple sclerosis (MS).

Simone Favre-Zimmerli,

PhD Senior Scientist

“We are working to discover new therapies that treat autoimmune diseases and their symptoms, but also that slow or reverse the progression of the disease.”

advance with our cladribine tablets,” says Dr. Andrew Galazka, who is leading the global cladribine research and development program in the company’s Biopharma business. Cladribine tablets are an oral medication that selectively and periodically targets the lymphocytes thought to be integral to the pathological process of MS. Cladribine tablets are currently under clinical investigation. Clinical trials have shown that taking this medicine orally for 20 days over two years can result in a long-lasting reduction in relapse rates. “The results show that the beneficial effects of cladribine tablets on the relapse rate are maintained in most patients for an additional two years without the need for redosing,” says Dr. Giancarlo Comi, Professor of Neurology, Chairman of the Department of Neurology, and Director of the Institute of Experimental Neurology at the Scientific Institute San Raffaele of Vita-­Salute San Raffaele University in Milan, Italy, and lead investigator of the studies. This would mean an enormous improvement in the quality of patients’ day-to-day lives. “I believe that use of agents that can reshape the immune system to gain long-term control of MS when the patient is in the early active phase of the disease will be the key treatment strategy in the near future,” says Comi. Merck is also investigating treatment options for other autoimmune diseases such as systemic lupus erythematosus (SLE). SLE can cause pain and swelling in the joints, skin rashes, extreme fatigue, and kidney damage or even failure. “I have personally met SLE patients and heard their stories, which motivates me to work even harder to find a treatment. Current trials on our drug candidate atacicept are showing great promise,” says Simone Favre-Zimmerli, a Merck researcher in Immunology. Other drug candidates are being investigated for patients living with chronic conditions including rheumatoid arthritis (RA), an inflammatory disease of the joints. “We are working to discover new therapies that treat autoimmune diseases and their associated symptoms, but also that slow or reverse the progression of the disease,” explains Favre-Zimmerli.

Dr. Giancarlo Comi,
lead investigator of the studies on cladribine tablets – a potential new MS treatment from Merck.

“The results show that the beneficial effects of cladribine tablets on relapse rate are maintained in most patients for an additional two years without the need for redosing.”

The MS treatment Rebif® was approved in Europe in 1998 and in the United States in 2002. It is registered in more than 90 countries around the world. In 2012, the European Commission approved an indication extension for use in early-stage MS.