A June 2024 literature review, published in the Lancet Neurology, by Sisodya and colleagues has revealed that climate change has the potential to intensify multiple sclerosis (MS) symptoms, as well as the incidence, prevalence, and severity of other major neurological disorders. In recent decades, making inferences about the effects of climate change on neurological and psychiatric disorders has been difficult given an overall sparsity of data, and little consideration was given to the effect it might have on individual and population genetics, making this review stand out as the first of its kind. The collated evidence aligns with forecasts made by GlobalData analysts and epidemiologists, who anticipate an uptick in the prevalence and disease severity of MS. This will drive significant growth in the MS market over the next decade as patients demand new treatments to manage their symptoms.
MS is a progressive, chronic autoimmune disease that affects the central nervous system as the insulating covers of nerve cells in the brain and spinal cord are damaged. The associated symptoms of MS include fatigue, numbness and tingling, muscle spasms, stiffness and weakness, mobility problems, pain, and cognitive issues, among others. A 2022 study conducted by Viktova and colleagues, and published in the American Academy of Neurology (AAN), suggests that there is an association between the increasing severity and susceptibility of MS and higher latitude temperature zones. Latitude lines ring the Earth and are parallel to the equator. The longer the distance from the equator, either north or south, the higher the latitude of the location. At higher latitudes, the Sun’s rays hit the Earth at a flatter angle, so the solar energy is spread over a wider area, making the atmosphere cooler. Viktova highlights that the increasing severity and susceptibility of MS at higher latitudes may be caused by low ultraviolet B exposure and low vitamin D concentrations. Conversely, once MS has developed, research indicates that warmer outdoor temperatures are associated with worsening MS symptoms. This is known as Uhthoff’s phenomenon, which is defined as a transient deterioration of neurological function among MS patients in response to increases in core body temperature. Fatigue, motor symptoms, sensory symptoms, and cognitive symptoms can all occur following an acute temperature elevation of just 0.5°C (0.9°F). Research conducted by Leavitt and colleagues, published in the AAN in 2012, posits that up to 80% of people with MS complain of heat sensitivity. Climate change poses a clear threat to the well-being of MS patients and could accelerate the progression of their disease.
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The main treatments for MS focus on slowing the disease’s progression and are disease-modifying therapies (DMTs). GlobalData estimates that sales for MS DMTs will grow to $30.1bn in 2030, at a compound annual growth rate (CAGR) of 4.7% from the 2020 base year. Climate change-related exacerbations of MS will necessitate the development of novel, more effective DMTs as disease flare-ups become more frequent with fluctuating temperatures. According to GlobalData’s Pharma Intelligence Center database, two Phase III MS clinical trials are being conducted at the time of writing. In these trials, novel treatments for MS are being actively compared to DMTs currently on the market. These trials involve Novartis’s remibrutinib and Genentech’s fenebrutinib. The remibrutinib trial, known as the REMODEL-1 trial (NCT05147220), is a global clinical trial that aims to compare the efficacy and safety of remibrutinib against Sanofi’s Aubagio (teriflunomide) in patients with relapsing MS. The second trial is a global clinical trial known as the FENhance trial (NCT04586010), in which fenebrutinib is also having its efficacy and safety assessed against Aubagio. These trials signify pharmaceutical companies’ interest in developing more effective DMTs, which is likely to grow as the severity of MS symptoms is magnified due to climate change, a potential driver of growth in the MS market.
Currently, there are no well-established strategies for managing neurological diseases in the context of climate change. Evidence suggests that health effects are even likely to occur in cities that are better equipped to deal with extreme temperatures, emphasising the urgent need for research and policy development. The review by Sisodya and colleagues calls for prospective, systematic, and disease-focused models of how climate change will affect the central nervous system. However, these will have to be coupled with new, more effective therapeutic interventions to form an all-encompassing coherent strategy for managing MS in line with climate change.
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