Thursday, 14 June 2018

NIH Grand Round: what is an IRT?

As promised the following is my slide deck from my presentation at the NIH grand round on Tuesday morning (12-June-2018). I was surprised to find out that none of the MSologists at the NIH prescribe DMTs; they leave the decision up to the treating neurologist. The NIH MSologists only see patients as part of research protocols. However, the resources at their disposal for research is quite extraordinary. They are a very privileged group of researchers.

After the meeting, someone asked me what excites me most about MS research at the moment? Can you guess what I said?




The following is a list of my top priorities in relation to MS-related research:

  1. MS prevention: EBV vaccination study.
  2. MS prevention: Treating infectious mononucleosis to see if we can reduce the risk of MS.
  3. MS prevention: a very large big-data population-based vD supplementation trial (The 'Gary Cutter' Trial).
  4. MS prevention: getting high-risk children to not get obese, to remain vD replete and not to smoke to hopefully lower their risk of getting MS.
  5. MS prevention: to create a trial ready cohort of people at high-risk of getting MS for future interventions (I have some ideas about what these should be).
  6. #ThinkPlasmaCell: to test treatment strategies to scrub the CNS clean of OCBs.
  7. #ClinicSpeak: to equip pwMS with tools to self-monitor and self-manage their MS and to get them to change the way they are managed by the healthcare system.
  8. #ThinkHand: treating more advanced MS to protect upper-limb function (ocrelizumab in PPMS and cladribine in progressive MS)
  9. #ThinkCure: deep phenotyping of patients in long-term remission post an IRT to see if we can define an MS cure.
  10. #BrainHealth: getting HCPs in the field of MS to think beyond NEDA and to treat-2-target of maximised brain health over the lifetime of their patients
  11. Neuroprotection: combination therapy trials to slow down or halt worsening of MS disability. It is folly to expect neuroprotection to work as a monotherapy; it needs to be on top of a high-efficacy DMT. 
  12. Remyelination and Neurorestoration: to test novel treatments to try to promote recovery of function in pwMS with disability.



ProfG    

15 comments:

  1. Is NIH short for nihilists?

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    Replies
    1. National Institutes of Health

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  2. I really like your list of priorities - makes me think about how complicated MS is and how multiple approaches are still required. I have less faith in Big-data though but wait in anticipation of being shown wrong in due time.

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  3. I like it; prevention, prevention, prevention.

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    1. Prevention, prevention, prevention is our new mantra. That is why I have taken on a new role as co-director of the Preventive Neurology Unit, which is embedded in the Wolfson Institute of Preventive Medicine in our medical school.

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  4. This is why I love this blog; it provides hope for people with MS and for future generations that have yet to develop MS. I hope you can make your ambitions a reality. Please let us know how we can help you.

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  5. How are you planning to prevent high-risk children from getting obese, to remain vD replete and not to smoke to hopefully lower their risk of getting MS? Surely this one ambition to far?

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    Replies
    1. It is difficult. This is why we launched Digesting Science a course to teach children of MSers about MS and the risk factors that predispose them to MS. The initial course focused on vD, but as we expand it we will cover the other topics.

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  6. 1.MS prevention: EBV vaccination study.

    All the rest is kinda nonsense..People who
    are overweight/daily smokers/never go in the
    sun...Most will never get MS.

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    Replies
    1. "Most will never get MS."
      That's the point of suitably powered studies (big enough samples) isn't it?

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    2. Re: "...All the rest is kinda nonsense"

      A tad cynical. We know about these risk factors. Why should we ignore them and not try and modify them?

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    3. "A tad cynical."

      No..it's just that cheap fast food has caused an obesity
      crisis in U.S. and Mexico..and with computers/videogames/netflix am sure people get less sun than ever..and yet
      no MS outbreak in last 5-10 years. It's too late for this stuff..hopefully 5 years from now it will be moot point
      as Dr. Sadiq and Atara Bio have immuno-nueral therapies that
      stop progression as sadly ocrevus isn't much better than placebo in the long term but that isn't something that's often/ever mentioned. So then we get posts like managing
      expectations in progressive disease. One can't really have
      any expectations with these drugs as they mostly don't get into the brain..to do so would be illogical..not cynical.

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    4. "A tad cynical."

      "I an not an Atomic Playboy..as one of my critics labeled
      me..exploding these bombs to satisfy my personal whim"

      Vice Admiral W.H.R. Blandy Commander of the Bikini Test

      https://www.youtube.com/watch?v=IE06ECcimb8

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  7. I agree with adam. It's unrealistic.

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