Research in primary progressive MS (PPMS) - National Multiple Sclerosis Society

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Research in PPMS


The National MS Society is funding research to help identify and address the differences between primary-progressive MS (PPMS) and other disease courses.

  • Researchers at the University of Texas Southwestern Medical Center are comparing the specific immune responses mounted by different types of immune cells in people with relapsing-remitting MS (RRMS) and those with PPMS. Understanding how immune cells respond in PPMS may lead to the development of an effective therapy to treat it.
  • At Brigham and Women’s Hospital in Boston, researchers are using novel imaging techniques to compare different parts of the brain in primary-progressive and other types of MS — which could eventually yield new strategies for predicting and monitoring MS progression.
  • At Johns Hopkins Hospital in Baltimore, researchers are comparing disability scores and optical coherence tomography (OCT – which measures structures in the back of the eye) findings with blood samples of people with varying levels of disability to determine whether different genes are expressed in people whose disability levels differ.
  • A new Collaborative MS Research Center at the Oregon Health Sciences Center is investigating possible causes for the degeneration of nerve fibers (axons) in the central nervous system.

Clinical trials

People who have received a diagnosis of PPMS are often frustrated by the relatively small number of clinical trials in PPMS compared to the large number in RRMS. MS clinicians and researchers share this frustration and are actively looking for ways to increase the number of trials of treatments for PPMS, addressing several obstacles:

  • The disease modifying medications currently used to treat relapsing forms of MS primarily target inflammation in the central nervous system (CNS). Because inflammation plays a much smaller role in PPMS than in relapsing forms of MS, these medications do not seem to be as effective in PPMS — which means that new treatment targets need to be identified.
  • In PPMS, there is a lack of easily-identifiable outcomes to measure in clinical trials. In the trials for the approved disease-modifying therapies, investigators looked at outcomes such as number of relapses and number of new lesions (also called plaques) seen on magnetic resonance imaging (MRI) to determine if people who received the treatment had lower numbers than those who received a placebo (non-active substance). The outcome measurements do not adequately quantify disease progression in the PPMS group.
  • Disease progression in PPMS can be quite slow, making the ability to identify an effect on progression difficult in a two- or three-year trial.

Researchers are working to understand why some people experience aggressive worsening of MS and others experience a milder course, and to identify other ways to measure the changes that occur in PPMS so that they can more easily test potential treatments.

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