AttackMS: how early should we use highly effective DMTs?
Research suggests that the earlier people with MS start treatment, the more MS damage and disability we may be able to prevent. But how early should MS treatment start? This is the question Professor Klaus Schmierer is trying to answer in the AttackMS trial.
Why did you set up the AttackMS trial?
Once people have a confirmed diagnosis of MS, they may become eligible to take a disease modifying therapy (DMT).
In some cases, diagnosis can be quick. But in others, an MS diagnosis can take weeks, months – or even years. Currently, the standard time to see a neurologist in the NHS is about 20 weeks. And starting treatment for MS commonly takes much longer.
In this trial, we want to see whether it makes sense to treat MS with the same urgency as cancer or stroke. If someone starts a highly effective DMT much earlier, within 14 days of experiencing their first MS-like symptoms, do they have better outcomes than someone who starts treatment after diagnosis? That’s what we’re testing.
Which treatment is being tested?
The drug we’re using in the trial is natalizumab (brand name Tyruko). It’s currently licensed as a first line treatment for people with rapidly evolving severe relapsing MS. It’s classed as a highly effective DMT.
Natalizumab works by blocking immune cells from entering the brain, where they can cause damage. We think that blocking MS inflammation early may help with natural myelin repair. Ultimately this could reduce the risk of disease progression and long-term disability.
Who can take part?
We’re recruiting people to take part in the trial through referrals from clinicians across the UK. These are usually A&E doctors or ophthalmologists (eye doctors), as they often see patients when they first present with optic neuritis, a common first symptom of MS.
People who are referred by a clinician will be invited to undergo screening for the trial, and, if eligible, they’ll be invited to take part. The trial takes 24 weeks. Participants are randomly assigned to take natalizumab or placebo for 12 weeks. All participants then take natalizumab for an additional 12 weeks. And all participants can be treated with steroids if deemed necessary.
We’ll look at whether people who take natalizumab earlier show better myelin repair. And if there’s a difference in disability between the two groups.
What could this mean for people with MS?
While many clinicians understandably want to be 100% sure of a diagnosis before starting treatment, it could mean precious time is lost.
Ultimately, we want to know how to best slow or stop disability progression in people with MS. AttackMS will give us the evidence needed to make the case for even earlier treatment and more urgent referrals of people with suspected MS. This could reduce the chance of disability progression for people newly diagnosed with MS right from the start.
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