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Is early intensive treatment best?

Dr Nikos Evangelou

On International Clinical Trials Day, read about Dr Nikos Evangelou’s new trial aiming to find out if early intensive treatment is best, and learn how the team are adapting to deal with the coronavirus pandemic.

There are over a dozen treatments available for relapsing MS, but we don’t know if there’s a link between the treatments you start with and how your MS develops in the long-term.

Balancing effectiveness with side effects

More intensive treatments have a stronger influence on immune cells, so they have a better chance of stopping your immune system attacking myelin. But it can mean your immune system is less able to fight off real invaders, like infections, increasing the risk of side-effects.

Researchers think progression starts early in relapsing MS, before a diagnosis of secondary progressive MS. Early treatment slows down the build-up of irreversible damage as well as reducing relapses.

So some neurologists think we should always give people with MS the most intensive treatment available from the start - as it might reduce your risk of long-term progression more than starting with a milder treatment. Others think we should go slow and steady.

But people with MS often tell me they only want to risk the side effects if the drug will definitely have a greater effect on progression. We can’t be sure what’s best until we’ve compared the two approaches.

A new trial

Our trial DELIVER- MS will help answer this question.

We’re comparing progression in people with who’ve recently developed relapsing MS. One group will start off with a milder treatment and only move on to a more intensive treatment if the first one doesn't effectively control their MS. Another group will start with a more intensive treatment. A third group will chose a treatment and we’ll monitor them to see what happens.

The research will help people with MS make the right treatment decision for them.

International collaborations

The DELIVER-MS trial came out of the MS Society's clinical trials network and a visit to Nottingham by Dr Daniel Ontaneda from Cleveland in the USA. We realised we’re both passionate about the question of early intensive treatment. So we developed the proposal together.

The trial is recruiting participants at centres across the UK and the USA. Working collaboratively with colleagues from all over the world is one of the most exciting parts of being a researcher. But we can get a bit competitive – they've recruited about 10 more people than us so far, so we're neck and neck!

Adapting to the COVID-19 pandemic

Right now, we don’t know how different disease modifying therapies (DMTs) affect someone’s risk of developing coronavirus or having more severe coronavirus symptoms.

We’re still recruiting people who’ve chosen a specific treatment option and observing them to see what happens. But we’re not randomly assigning people to receive a particular treatment.

We’re carrying out assessments by phone to see how people are doing on different treatments. The trial uses MRI scans to track progression but we can’t do those at the moment because of the social distancing guidance. We’re planning to start up again when it’s safe to do so.

We already used to communicating with colleagues virtually as there are trial sites in the UK and US. So that hasn’t been a problem!

Read about DMTs and COVID-19

If you're newly diagnosed (within 5 years) and about to start treatment, find out how you can take part in DELIVER MS.

Help us learn more about DMTs and coronavirus by completing the MS Register survey.