Barts-MS rose-tinted-odometer N/A
Yesterday’s PMSA meeting was very interesting. It is clear the field of MS is at a cross-roads and that Pharma needs the wider MS community to help them change the game. If we don’t I suspect we won’t see the next generation of treatments being developed to target the ‘real MS’ or ‘smouldering disease’.
It was clear that combination therapies are needed, but how we make them happen is another story. Regulators need to understand that we need to go beyond inflammation and treat MS as one disease. I tried to convey this message in my presentation. What I am staying is the real MS is essentially primary progressive MS or smouldering MS. Our anti-inflammatory therapies convert relapsing forms of MS into primary progressive MS and we, therefore, need to combine these groups, i.e. those who are NEDA-2 and getting worse into one group for add-on trials.
My proposal to oncologise MS and create a trials platform was presented by both Jeremy Chataway and Ludwig Kappos. It is reassuring that these two giants of the MS world are supportive of the idea. I have therefore designed the skeleton of an O’ADD-ON and DADD platform for discussion. In reality, these platforms should have been set-up yesterday.
Doing registry-type trials is now the norm in most fields of oncology. I, therefore, see no reason why we can’t steal their ideas and apply them to MS. The question which fish will bite first; Roche or Biogen? There is nothing like a bit of competition and the fear of missing out (FOMO) to get people to act.
What do you think of these platforms? I am very interested to hear if you think this is feasible or not? An ocrelizumab and/or DMF platform will at least create the base for Roche and Biogen to develop their own add-on compounds but will allow them to partner with other Pharma companies, for example, Abbvie and elezanumab, and with academia. Although these platforms will be expensive I am sure the investment will pay massive dividends down the line for pwMS, society and industry.
CoI: multiple
P.S. In response to some of the comments below. The following infographic is a crude attempt to explain what I mean when I say that current DMTs convert RRMS into PPMS or smouldering MS. PwPPMS simply have a much longer asymptomatic and prodromal phase so that when they present with symptoms and get diagnosed they have lost more brain and spinal cord. In other words, pwPPMS have more advanced MS and have less reserve compared to people with early relapse-onset MS. The latter explains why the treatment response is less in both SPMS and PPMS.