Despite significant progress in the development of treatments for people with relapsing forms of multiple sclerosis, there are few treatment options for people with progressive forms of MS
. The newly formed International Progressive MS Collaborative has published an opinion paper outlining challenges in developing therapies for progressive MS and identifying key research priorities to propel efforts to stop MS progression. The Collaborative is the greatest effort to date aiming at speeding research on progressive MS, and is formed of the MS Societies of Canada, Italy, Netherlands, the UK and the US, and the MS International Federation. The paper, by lead author Robert J. Fox, MD (Mellen Center for Multiple Sclerosis, Neurological Institute, and Lerner College of Medicine, Cleveland Clinic) and colleagues, identifies five key priority areas for research, and was published in the Multiple Sclerosis Journal (Online First, August 23, 2012
“Overcoming the challenges of progressive MS is a key objective of the Society’s Strategic Response to MS,” says Timothy Coetzee, PhD, Chief Research Officer of the National MS Society and member of the Collaborative. “This is just one of the ways we’re collaborating worldwide to speed clinical trials in progressive MS.”
The hopes of most people who have MS today rest on finding a way to stop disease worsening and reverse the damage to restore lost functions. MS progression can be slow or it can be fast, but most agree that it occurs in the majority of those who have the disease, even those successfully treated for relapses.
There’s been a great deal of progress in treating relapsing forms of MS, with many FDA-approved therapies. But for every new therapy approved for relapsing forms of MS, people with progressive MS, for whom there are few significant treatment options, feel left behind. Virtually every therapy approved for relapsing MS has been tested, or is now in testing, in people with progressive forms of the disease. Up to now, clinical trials involving people with relapsing MS often rely on counting relapses or doing MRI scans to detect immune activity. The fact that there is no easy way to detect progression quickly is one reason why drug development for progressive MS is behind.
The mission of the International Progressive MS Collaborative is to expedite the development of effective disease modifying and symptom management therapies for progressive forms of MS. To do so, research efforts are needed on several fronts to lay the groundwork needed to identify possible therapeutic targets and conduct clinical trials aimed at stopping progression of the disease.
The Research Agenda:
Through a series of meetings, the collaborative has identified five key research priorities for progressive MS.
Experimental Models – There is an urgent need for animal models that more clearly reproduce the clinical symptoms and underlying tissue damage seen in progressive MS.
Identification and Validation of Targets and Repurposing Opportunities for progressive MS – Insights for identifying new targets may come from advances in MS genetics, or from re-evaluating drugs that are approved for other indications.
Proof-of-Concept Clinical Trial Strategies – New clinical trial strategies are likely to involve biomarkers that measure important events in nerve fiber injury [which contributes to the progression of disability] and correlate with disability, and trial designs that minimize trial size and duration.
Clinical Outcome Measures - The ideal measurement would be sensitive to change over time, and predictive of future change. The authors note an effort already underway to revise the MS Functional Composite – read more.
Symptom Management and Rehabilitation – More well controlled trials are needed to evaluate symptomatic therapies and rehabilitation methods, particularly cognitive rehabilitation interventions.
“Tackling these issues will require an integrated, multi-disciplinary approach to enable effective translation of research into therapies,” wrote the authors. “The time is right for concerted action.”
The Collaborative commissioned five working groups to identify strategies and potential lines of research within each area. An international meeting is set for February 2013, where plans will continue for moving this research forward.
about research on progressive MS.