1st December 2021
Leaders of the International Progressive MS Alliance have published a paper proposing a global research strategy to prioritize and coordinate efforts needed to find more and better treatments and improve quality of life for people living with progressive MS. The paper outlines recent successes and advances specific approaches for understanding mechanisms underlying progression, accelerating clinical trials, and improving well-being through rehabilitation and symptom management innovations.
“The publication of this paper is an important step toward a more coordinated, global approach to tackling challenges and realizing opportunities for improving quality of life for people living with progressive MS,” said first author Professor Alan Thompson, Pro-Provost and Dean of the UCL Faculty of Brain Sciences. “The ideal is to have global stakeholders engaged and working together to speed progress and dramatically increase the likelihood of success,” he added.
Background and Details
- Despite progress in the development of anti-inflammatory therapies for multiple sclerosis, the few treatments approved for progressive forms of MS – which affect 1 million people worldwide – are only modestly effective.
- The development of progressive MS likely involves a combination of factors, including brain and spinal cord damage from inflammation, neurodegeneration, and aging. The body may compensate for these processes for a time, and other factors such as sex, race/ethnicity, socioeconomic status, comorbidities, genes, and the use of MS disease-modifying therapies likely play a role in any individual’s disease trajectory.
- Given this evolving view of progressive MS, the Alliance’s Scientific Steering Committee undertook a literature review and held several meetings to survey the landscape of current knowledge and develop consensus on strategies to overcome gaps in the treatment and management of progressive MS. This culminated in the publication of the strategy paper.
- The paper summarizes recent advances in identifying factors that influence MS progression, and clinical trials of experimental therapies offering suggestions that progressive phases of MS are responsive to treatment. It also includes a graphic that summarizes experimental therapies in the development pipeline, including symptomatic treatments.
- Three gap areas are identified as holding potential for accelerating progress, with suggestions for research approaches and critical steps to tackle them:
- Understanding mechanisms that drive progression: Having deeper knowledge of the underlying causes of progression will uncover plausible treatment targets to slow, prevent, and even reverse disability. Increasing data sharing and application of machine learning may support progress in this area, as will having disease descriptors that are based on biological phenotypes, an effort already underway.
- Speeding clinical trials: MS progression is generally slow and there is no quick way to detect whether an experimental therapy is working. To increase testing of novel agents, new trial designs that require fewer participants are needed, as well as fluid and imaging biomarkers and clinical outcome measures that give early reflections of treatment response.
- Improving wellbeing: More attention is needed to test and disseminate effective approaches to address the physical, cognitive, and emotional health symptoms experienced by people living with progressive MS. This necessitates an increase in the trained workforce and investments in high-quality research in these areas.
- The paper points to international collaborative research efforts already underway to address some of these pressing issues. The authors also highlight the need for all parties, including people affected by progressive MS, funders, academic researchers, the pharmaceutical industry, and drug regulators to be engaged, to have awareness of the challenges, and to work toward a more coordinated approach to solving them.
“Charting a global research strategy for progressive MS—An International Progressive MS Alliance proposal,” by Alan J Thompson, William Carroll, Olga Ciccarelli, Giancarlo Comi, Anne Cross, Alexis Donnelly, Anthony Feinstein, Robert J Fox, Anne Helme, Reinhard Hohlfeld, Robert Hyde, Pamela Kanellis, Douglas Landsman, Catherine Lubetzki, Ruth Ann Marrie, Julia Morahan, Xavier Montalban, Bruno Musch, Sarah Rawlings, Marco Salvetti, Finn Sellebjerg, Caroline Sincock, Kathryn E Smith, Jon Strum, Paola Zaratin and Timothy Coetzee, was published in Multiple Sclerosis Journal online on December 1, 2021. This is an open-access paper that can be read in full by anyone.