Summary: A series of articles and commentaries by top MS researchers and patient advocates published in the February 2015 issue of Lancet Neurology outlines recent advances and urges the MS research community to focus on finding solutions for people with progressive MS. More than one million people are living with progressive MS, a condition which remains frustratingly elusive to diagnose and treat. The authors review the state of knowledge and recent advances, and make specific recommendations for studying disease mechanisms, developing innovative new ways to conduct clinical trials, and finding better ways to manage symptoms. They also highlight the efforts of the international Progressive MS Alliance as a major step forward in achieving these goals. The articles can be viewed until early in March; registration on the Lancet website is necessary, but there is no charge.
Details: Following are brief highlights from these papers, with links to the complete articles:
What causes progression? Drs. Don Mahad (University of Edinburgh), Bruce Trapp (Cleveland Clinic) and Hans Lassmann (Medical University of Vienna) review an ever-increasing understanding of the kind of nervous system damage that leads to progressive disability in people with MS. These include oxidative injury (a process wherein “free radicals,” normal byproducts of bodily processes, cause nerve tissue injury) and injury to the mitochondria (energy-producing bodies within nerve cells). These injuries, generally thought to be launched by MS attacks, are then amplified by age-related changes in brain activation. As much progress has been made, however, the there is a need for laboratory models that truly represent the chronic stages of injury in MS to move this research forward. Read more
Symptom treatment: What works? Drs. Anthony Feinstein (University of Toronto), Jenny Freeman (Plymouth University) and Albert Lo (Brown University) review clinical trials of treatments or rehabilitation focusing on MS symptoms. Their main finding is that too few studies involve solely people with progressive MS, and that these studies are sorely needed to determine effectiveness in this population. This research takes on greater significance in the absence of disease-modifying therapies for progressive stages of MS. The authors suggest that testing several interventions at once may truly launch this research forward. Read more
Lessons learned from clinical trials: Drs. Daniel Ontaneda (Cleveland Clinic), Robert Fox (Cleveland Clinic), and Jeremy Chataway (Queen Square, University College London) review the frustrating history of negative results from phase III treatment trials in people with progressive MS. Their comprehensive review offers lessons learned and concrete strategies for turning these to positive outcomes. These include the need for better clinical measures of effectiveness, including cognitive testing and patient-reported outcomes; recommendations for better trial designs and conducting trials for at least 36 months;; and using advanced imaging tools and spinal fluid biomarkers to track treatment benefits. Read more
Overcoming barriers: Dr. Timothy Coetzee (National MS Society), Dr. Paola Zaratin (Italian MS Foundation) and MS blogger Trevis Gleason comment that increased focus is necessary in three areas: research collaboration, regulatory innovations (regulatory authorities have less experience with progressive forms of MS and may expect trials that are too onerous to perform in progressive MS); and sustained and increased research funding. The launch of the international Progressive MS Alliance, which just released its second request for research proposals to foster international collaboration, bodes well for these goals. Read the commentary
A much-needed focus: Dr. Alan Thompson (University College London) comments, “Every time a new treatment for RRMS comes on the market, it serves to remind people with progressive multiple sclerosis that they are still waiting…” He notes that the most fundamental issue in developing new treatments is the need to understand the events that lead to the development of progressive MS, and a close second is the need for innovative trial design. He also encourages new approaches to rehabilitation. He notes that the international Progressive MS Alliance, for which he serves as Chair of the Scientific Steering Committee, is focusing on this daunting challenge with a mission to develop effective treatments and symptom management. Read more
This series of articles points to some significant progress made in addressing the challenges of progressive MS. It also points to the urgent need to solve these challenges. The international Progressive MS Alliance is putting the framework and funding in place to help drive this research forward, with the sole objective of improving the lives of people with progressive MS.