Will we ever learn? Just need to Read and Assimilate. Is it too much to Ask?

Results of a mycopheylate study in PPMS

Looks like mycophenolate is down the tube as far as progressive MS goes?

I wonder are Neuros doing their upmost to ensure that we don't deliver treatment options

Fakih R, Matiello M, Chitnis T, Stankiewicz JM. Efficacy and safety of mycophenolate mofetil in progressive multiple sclerosis patients. J Neurol. 2018. doi: 10.1007/s00415-018-9050-1. [Epub ahead of print]

OBJECTIVES: There are increasingly effective therapies for relapsing forms of multiple sclerosis (MS); however, the options for the progressive patient population are limited. The effect of mycophenolate mofetil (MMF), a disease-modifying agent for several autoimmune diseases, in progressive MS has not been explored effectively. We performed a prospective study to assess the safety and efficacy of MMF in progressive MS patients.
METHODS: We identified 64 patients enrolled in the comprehensive longitudinal database at the Partners MS Center, who fulfilled our inclusion criteria. They were exposed to MMF for at least 1 year with recorded clinical outcomes. Efficacy was assessed by comparing the absolute relapse rate (ARR), and the mean Expanded Disability Status Scale (EDSS) and timed 25 foot walk (T25FW) test scores before and after MMF treatment.
RESULTS: At the start of MMF, 78% of patients (n = 50) were in the 4-7.5 EDSS range. There was a slight increase in mean EDSS from 5.49 ± 1.65 (n = 48) 1 year before MMF start to 5.85 ± 1.56 (n = 48) 1 year after (p = 0.020). The mean T25FW score increased 1 year before MMF from 12.3 ± 9.6 s (n = 38) to 15.6 ± 12.3 s (n = 38) 1 year after (p = 0.009). The ARR in the 2 years pre-MMF period was 0.30 ± 0.63, which decreased to a 0.09 ± 0.29 (p = 0.022) 2 years post MMF.
CONCLUSION: MMF did not affect disease progression but did influence relapse rate. We believe that other medication options should be considered before MMF in advanced progressive patients.

We just seem to be a load of Ostriches who stick our heads in the sand and plough-on without learning anything. 

Maybe because we are incapable of reading other people's work and assimilating what these papers say, we seem to go from one failed progressive study to the next when using immunosuppressive agents.

I don't think I am that bright, but at least I can read just about (OK I'm dyslexic).

I would be very surprised if we did not get the results presented in this paper, as we have seen them over and over again.

We know that relapses respond to immunosuppressive agents and indeed that was suggested. 

You can see effects of DMT on gadolinium enhancing lesions within 6 months and relapses within a year, but for progression there is no chance.

So, likewise it was found that there was worsening of lower limb function, which is found in people taking alemtuzumab, ocrelizumab and HSCT, etc. etc, etc., etc., ugh!. 

However, a trial of 64 people is too low to make any firm conclusions and a 12 month trial is too short to detect any meaningful change on lower limb function. 

Although this isn't a trial and there can be further follow-up, no doubt this paper will now be used to show that mycophenolate is of no value to control progressive neurodegeneration.

Maybe that is the case, maybe it isn't

Maybe it would be if the study was longer and different outcomes (e.g hand function) were used and importantly if a neuroprotective/repair agent was put on top of the immunosuppression. I guess they can come back in 2 years time and give us the answer.

However, without some control arm will we know if a slowing of worsening occurred.

Why do I say this?

Behind the scenes we have been looking for agents to control progression, but the question I pose is, will we learn from the past or plough-on with the same old trial design..regardless.

However it does show that there is benefit to be had in so-called progressive MS as the relapsing elements clearly respond. However we need to be laying treatments within the therapeutic pyramid, probably with an induction therapy/immune-reconstitution therapy on the bottom