The ECTRIMS congress is a great place for researchers, clinicians, neurologists, multiple sclerosis (MS) Societies, organizations to all meet up and discuss the progress of developments in the MS field. It is also an opportunity for the MS Society research team to catch up with some of the researchers that we directly or indirectly fund. The research team had the opportunity to connect with some of our fantastic researchers that are working on the Canadian Pediatric Demyelinating Disease study, led by Dr. Brenda Banwell, Chief of the Division of Child Neurology and Professor of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania. Introducing Dr. Robert Brown and Dr. Giulia Fadda:
What is the difference between clinical trial data and real-world evidence? Let’s look at a new drug being investigated for treatment of MS. Before a drug can be approved by a health authority such as Health Canada, the drug must go through the clinical trial process. If a drug has shown promise, it will likely reach a phase 3 trial involving at least 1,000 individuals. Clinical trials are highly controlled, where study participants take the medication being investigated (or mock drug) as prescribed under the watchful eye of a research team. Before the trial even begins, desired endpoints (such as annual relapse rate, lesion load, disability progression, and brain volume mass) are established and will be used to measure the efficacy and safety of the drug in humans. Data from phase 3 trials that meet the desired endpoints in a statistically significant way, along with safety data reported during the trial, will be assessed by Health Canada in order to make a regulatory decision, or approval.
Cognitive impairment is a common symptom experienced by people with multiple sclerosis (MS), affecting quality of life and ability to work. Treatment strategies to manage cognitive dysfunction are an unmet need and viable solutions are still required. An area of considerable interest at the #ECTRIMS2018 congress was cognition and the importance of finding solutions to improve cognitive difficulties. Researchers addressed some important questions on this topic
What can alter cognitive function in people with MS?
Which subgroups of progressive MS should be treated?
Dr. Xavier Montalban, professor at the University of Toronto, presented an overview of treatments in progressive multiple sclerosis (PMS), beginning the talk with why drugs in PMS fail. Firstly, the pathological processes involved in PMS compared to relapsing-remitting MS are different, therefore novel treatments to target the processes in PMS are needed. Second, the patient population that is recruited for the clinical trials are not appropriate to identify the benefits of treatment. Finally, the current outcomes used in clinical trials to determine effects of treatments are not sensitive measures. Based on the evidence collected from PMS clinical trials, there tends to be a better response in people with PMS with prior relapses, rapidly evolving disease, active baseline imaging, younger individuals, shorter disease duration, treatment naïve and lower disability score. For clinical trials in progressive MS to be effective, key questions needs to be answered:
In active PMS, is persistence of relapses or worsening of disease the definition of treatment failure?
In PMS that is not-active, is disability worsening or appearance of relapses the definition of treatment failure?
How long should treatments be administered to evaluate treatment efficacy?
What measures should define an effective treatment?
The Multiple Sclerosis Society of Canada announced last month a $5 million grant in support of the first, international, multicenter clinical trial to investigate cognitive rehabilitation and aerobic exercise in improving cognition in people with progressive multiple sclerosis. Want more information on this trial? Check out the blog or MS Update. The research team had the opportunity to catch up with quite a few of the members coordinating and researching this project as they gathered at #ECTRIMS2018 to discuss project details.
Overview of the growing list of potential risk factors for MS
Dr. Ali Manouchehrinia, Assistant Professor at the Karolinska Institutet, presented an overview of the risk factors for MS. Firstly, he discussed the genetic variants associated with increased risk for developing MS. To date, there are 233 variants identified that have been linked to MS. Geographical distribution of MS also hints toward the involvement of the environmental factors in increasing MS risk. Other factors that have also increased MS risk are Epstein-Barr Virus, smoking, increased BMI (particularly in individuals that have high BMI before the age of 20). Finally, Dr. Manouchehrinia concluded the talk by discussing the interaction between genetic and lifestyle factors. Both low vitamin D levels and high BMI and genetics increase the risk of MS. Overall, there is a growing list of environmental and lifestyle factors, and interaction between the two, associated with increased risk of MS.
Salt: Is there evidence to support it as a risk factor in MS?
The MS Society of Canada’s research team is preparing to fly over the Atlantic to the exciting city of Berlin, Germany to attend the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) from October 10-12, 2018.
Cognitive impairment, a research priority for the MS Society of Canada, affects a significant proportion of people living with MS.
Multiple sclerosis (MS) can cause a reduction in brain size (also called brain atrophy). Research has shown that this atrophy and lesions developed in MS can be linked to the presence of cognitive difficulties. Cognitive difficulties affect up to seventy percent of individuals living with progressive MS, predominantly impacting information processing and speed, learning and memory, executive function and perceptual processing. Also, individuals themselves have voiced cognitive impairment as an area of concern that needs to be addressed.
Five years ago, I traveled around the country and engaged the MS Community (researchers, caregivers, individuals living with MS) to find out what areas of research are important to them—cognition and mental health was one of them!
While researchers are forging ahead with great ideas in symptom management and rehabilitation, we also heard about the complexity of factors that affect an individual with multiple sclerosis (MS) that need to be kept in consideration when developing new projects and initiatives. Therefore, in the third and final blog series on the progressive MS Alliance meeting, I will be highlighting fatigue management, understanding how comorbidities impact MS, and the mood and resilience of people living with MS.
Taking the lessons learned from stroke research (part 1) and moving forward to develop new projects and programs is important for the advancement of research in rehabilitation and symptom management in progressive multiple sclerosis (MS). For this post, I’ll be highlighting areas that garnered interest at the Progressive MS Alliance meeting such as brain stimulation, robotics, exercise, cognition, and patient perspectives.