Friday, 19 September 2014

MS Research Day. Why haven't we cured MS yet

Today ProfG presents

Q & A
Siblings trial was done by Dr Dobson a while ago, are there any results and where can they be found?The paper is now being looked at by one of the journals. What we did find that between the healthy people and people with the disease the siblings are half way between the two. The whole purpose of looking at the siblings was to see whether we can define an intermediate state, in people who are at risk of the disease and who don’t get the disease. I think I can say that we have found an intermediate state but can we now apply it clinically?. The whole idea was to go to a population and identify people for prevention trials. Ruth Dobson’s study is not about causation, it is about prevention. Can we identify high risk people and then do a prevention study on them? We are at the very beginning of that phase, so Ruth showed that we can identify these high risk people and it is now how do we explain this prevention study to a general population?

If the hypothesis is wrong that you have been working with that it is autoimmune condition, what does it mean for everybody here and who currently has a diagnosis of MS, and what does the future have for us basically?
Well, what it means is we will probably have a different type of therapy. I put on the slides the Epstein-Barr virus, it is a virus that probably has the strongest link to MS with everything. That particular virus lives in B cells. For all the very effective therapies in MS, it is the case that every one of them targets B cells. The only common thing to all of the therapies is B cells. Maybe all of these drugs are indirectly working against the virus. One of the current drugs that is at the late stage development, is a drug called Ocrelizumab. This is a drug that depletes B cells. We may find out how the drug works and it may have no implication for the field in general or we may need to bring new types of drugs targeting viruses. All I am saying is that the autoimmune hypothesis doesn’t have to mean autoimmune disease, it may not be, it may be something else that causes the inflammation. These are all treatment strategies.

I saw in statistics recently that in England only 18% people with MS receive the drug treatment comparing to people in the continental Europe it is about 30% and in the US it is about 50%. It may of course have a lot of reasons, but obviously finding cure depends on being treated , so is there any evidence so far suggesting that we are in Britain doing as well as other European or American counterparts?
Well, we don’t have the British comparison. At the latest meeting that I have been to, called MS Base Registry, which is run from Australia where they get information from all over the world. It is quite outstanding that in Australia you will do much better than if you live in Europe. The difference between Australia and Europe is that Australian neurologists have access to all the effective therapies very early, and it is clearly driven by those people who got onto the most effective therapies very early. The earlier the better. There is data, it does not compare the UK to most of the Europe, the real comparison, and they are doing it right now, will be between New Zealand and Australia. They are geographically similar. Although New Zealand is probably even more restricted than the UK in terms of access to therapies. I am very sure that MS Base will show that if you are a person with MS in New Zealand you will do much worse than if you are an MS patient in Australia. This is the kind of data we need to convince the funders that we really need to treat the disease a lot more actively than we are currently treating it. There is whole lot of cultural reasons why we are behind the curve in terms of adoption of treatments, but I think we will overcome this with data. The problem is that the initial lot of drugs were not that effective and now we have much more effective therapies and we see much better results. Hopefully with the current guidance coming out, we will have access to the effective therapies much earlier.

6 comments:

  1. I heard that Dr Dobson's study was unsuccessful and MS cannot be 'predicted'?

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  2. What current guidance is coming out re access to early effective therapies?

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    Replies
    1. Don't live in England/UK :-)

      In league table of access to drugs we are about second from bottom, i think Poland is below UK and German is on top in EU

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  3. "MS cannot be predicted".....There is nothing absolute about MS and as to risk factors we know but a few. These have small increases in risk. It may be there are 400 susceptibility genes but how many do you need to get MS?.....I don't know yet only about 160 have been identified.

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  4. I've seen this slides from Prof G many times that shows a split 20 years out for the auto-immune and neurodegenerative hypotheses. I think I understand the general concept, but could you do a post explaining this differences and/or mechanism more clearly? I think this would help many of us with MS understand why we need to wait so long for a definitive "cure".

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  5. Please tell us something about this 'intermediate state' between having and not having MS.
    Is it something like RIS?

    Based on what you know of the science, natural history, etc and based on your own ideas and experience, even if there is no proper evidence:
    What can siblings do to prevent the transition from the intermediate state to proper MS?

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