Progressive MSFriday, October 04, 2013, 14:00 - 14:20
From relapsing-remitting to secondary progressive MSR. Fox (Cleveland, US)
With ten approved therapies for relapsing MS and strong imaging biomarkers to screen new anti-inflammatory therapies, relapsing MS has been transformed into an imminently manageable disease. In stark contrast, treatment of progressive MS remains an enormous unmet challenge. Several initiatives are addressing this challenge. The International Progressive MS Collaborative identified five key priority areas for research: 1) identification of experimental models that reproduce the key clinical and pathological features of primary and secondary progressive MS; 2) identification and validation of biologic targets and opportunities to repurpose existing medicinal compounds for progressive MS; 3) identification and validation of proof-of-concept clinical trial outcomes to provide what gadolinium-enhancing lesions provide to relapsing MS; 4) development of precise, reproducible, and broad-based clinical outcome measures which are both sensitive to change and predictive over time; and 5) symptom management and rehabilitation strategies which can help reduce the impact of disability and improve quality of life in both progressive MS and relapsing MS. The MS Outcome Assessments Consortium (MSOAC) is bringing together industry, academia, patient representatives, regulatory and other government agencies to develop and obtain regulatory approval for clinician-reported outcome measures for use in progressive MS. The International Advisory Committee on Clinical Trials in MS has worked to refine the diagnostic criteria for progressive MS and improve clinical measures so that MS progression can be better tracked over time. Several innovative progressive MS trials are underway: the UK-based MS-SMART trial is a placebo-controlled trial evaluating three different therapies in secondary progressive MS; the US-based SPRINT-MS trial will utilize the NeuroNEXT Phase II clinical trial network to both evaluate a novel therapy and directly compare advanced MRI and OCT imaging biomarkers to identify the most reliable, sensitive, and robust biomarker for use in progressive MS trials; and additional trials evaluating siponimod, personalized T-cell immunotherapy, and intrathecal rituximab, among others. Clearly, many challenges remain for progressive MS, but targeted research efforts will accelerate the development of progressive MS therapies.
Dr. Fox has received consulting fees from Allozyne, Avanir, Biogen Idec, Novartis, Questcor, Teva, and Xenoport, and research support from Novartis.