The National MS Society is pursuing all promising research paths and collaborating worldwide to drive progress in research in progressive MS, for which few therapies exist.
Finding Solutions for Progressive MS
In progressive stages of MS, there are few or no relapses, and few or no recovery or remission periods when major symptoms improve. Some of the burning questions that are being addressed through research include:
• What factors influence the transition from relapsing stages of MS to progressive MS?
• Can the disease-modifying therapies prevent, delay, or slow long-term MS progression?
• What new therapies will stop progressive MS?
• What causes degeneration of nerve fibers—thought to be the cause of long-term disability—and how can that be stopped or reversed?
Driving treatment solutions
A common question is, “Why aren’t there more treatments for progressive MS?” Virtually every therapy approved for relapsing MS has been tested, or is now in testing, in people with progressive forms of the disease. Clinical trials involving people with relapsing MS often rely on counting relapses or doing MRI scans to detect immune activity. Progression is less easily measured, and usually happens over long periods of time. This important difference makes it hard to quickly detect whether a therapy is impacting progression, and thus has made therapy development for progressive MS a challenge.
But the landscape is changing, thanks in part to National MS Society investments and collaborations:
- The experimental therapy ocrelizumab moderately slowed the progression of disability compared to placebo in 732 people with primary progressive MS – the first large-scale clinical trial to show positive results in primary progressive MS; the company plans to seek marketing approval from the FDA in 2016.
- The Society is funding several clinical trials of nervous system-protecting approaches:
- Lipoic acid, an antioxidant that may help block nerve fiber damage in MS.
- Determining whether a biomarker can monitor the benefits of oxcarbazepine (epilepsy therapy) in people with secondary-progressive MS
- The MS-SMART trial is testing three therapies that may have nerve-protecting properties in secondary-progressive MS (with the MS Society of the U.K.)
- A unique collaboration between NIH's NeuroNEXT Network and MediciNova for a trial (SPRINT-MS) of ibudilast, an oral anti-inflammatory agent, in 250 people with progressive forms of MS.
- Large clinical trials are ongoing in progressive MS, including tests of masitinib, laquinimod, and siponimod.
- The International Progressive MS Alliance – an ever-expanding alliance of organizations from around the world – is funding research studies in 11 countries as part of a €22 million global effort to end progressive MS. www.EndProgressiveMS.org
- Studies investigating complementary and non-traditional therapies to combat specific symptoms, such as whether leg cycling can improve spasticity.
- More than 30 studies investigating benefits of novel programs of exercise, rehabilitation and other non-pharmaceutical strategies to enhance wellness, and address other symptoms that can interfere with quality of life. The Society has launched a wellness initiative to develop strategies for increasing high-quality research and programming that will help people with MS make informed lifestyle and wellness choices aimed at helping them live their best lives.
- The Society-supported MS Outcome Assessments Consortium is working on a new measure of MS disability to improve the chances of successful clinical trials in MS, including progressive MS.
Understanding what drives progression and how to stop it
Researchers are exploring mechanisms that drive injury to the brain and spinal cord to expose new potential therapeutic targets along the injury pathways that may stop the damage. These include:
- Large-scale studies tracking people with MS to identify factors that contribute to progression risk.
- Advanced imaging and laboratory studies seeking to define and track the full measure of MS disease activity, MS lesions, and atrophy (shrinkage) in the brain and spinal cord.
- Exploring the potential of different types of stem cells to repair the nervous system in models of the disease, and ways to enhance the survival of repair cells in inflamed and scarred nerve tissue.
What are the solutions for people with progressive MS?
We are relentlessly pursuing the answer to this question each and every day. Identifying and moving solutions forward is how we will succeed in stopping the progression of MS.
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