And to help people at every stage of MS, we need to stop MS from progressing. Researchers are looking at three ways to do this. And we’ve now reached the point where there are clinical trials in progress for all three.
1. Can we prevent immune damage at every stage of MS?
In MS, immune cells attack the protective myelin coating around our nerves. We’ve made incredible progress in our ability to stop the immune system attacking myelin. There are now more than a dozen disease modifying therapies (DMTs) available for relapsing MS that help do this. But there is still work to be done.
We don’t know if there’s a link between the treatments you start with and how your MS develops in the long-term. The DELIVER-MS trial will help to answer this question.
Researchers will compare escalation treatment (where you start with a milder treatment and switch to more intensive treatments if they don’t control your relapses) with early intensive treatment (where you begin on an intensive MS treatment straight away).
DELIVER MS is currently recruiting people with relapsing MS who have not previously received any DMT. There are sites open across England and Wales. You can find out more on the DELIVER MS website.
Progressive MS trials
We’re also starting to make headway in progressive MS as well. Ocrelizumab is now available for people with early progressive MS. And just last month, siponimod was approved for use on the NHS as the first oral treatment for people with active secondary progressive MS.
But to make sure that everyone with MS has access to effective treatments, we need to know whether targeting the immune system can still be effective at more advanced stages of MS.
Traditionally, walking ability has been the main measurement of whether a drug is effective. So, many people who use wheelchairs have been unable to take part in MS trials. But now, new trials are exploring whether drugs that target the immune system are able to slow down the worsening of hand and arm function for people with advanced progressive MS.
The ORATORIO-HAND trial is already testing whether ocrelizumab could help people keep using their upper limbs. And a new trial called ChariotMS will test whether cladribine, a drug already used to treat relapsing MS, can do the same.
ChariotMS will be recruiting people with advanced progressive MS. They are hoping to open to the first participants very soon. Read more about ChariotMS.
2. Promising results in myelin repair trials
Our bodies have an amazing natural ability to repair myelin. But this repair becomes less effective over time and doesn’t work as well as it should in MS. Researchers are exploring ways to kick-start this natural process again.
In September 2020 results from our bexarotene clinical trial showed myelin repair is possible in humans.
Unfortunately, participants in the trial experienced some serious side effects, which means bexarotene won’t be taken forward into further trials.
Metformin and clemastine
But now a new trial of the diabetes drug metformin will build on this work. Promising results from laboratory studies showed metformin could repair myelin in rats. Our new trial, led by Professor Alasdair Coles at the MS Society Cambridge Centre for Myelin Repair, will test whether metformin in combination with clemastine (an antihistamine) can repair myelin in people with relapsing MS.
The metformin and clemastine trial will recruit 50 people with relapsing MS. Participants will be recruited from Addenbrooke’s Hospital in Cambridge.
3. Testing treatments to protect nerves from damage
As well as playing a vital role in how nerves work, myelin also protects them from damage. Without their protective myelin, nerve cells are vulnerable. So we need to make sure our nerves are happy, healthy and protected from damage.
Previous research has suggested that simvastatin, a drug initially developed to lower cholesterol, was also able to improve levels of disability and slow disease progression in MS.
We’re now funding MS-STAT2, the final definitive trial to show whether simvastatin can slow progression in secondary progressive MS by protecting nerves from damage.
MS-STAT2 is currently recruiting people with secondary progressive MS at sites across the UK. You can find out more on the UCL website.
Speeding up clinical trials
With every step of our plan to stop MS underway, we believe treatments that slow or stop disability progression for everyone with MS are now a very real prospect.
Our next project is to speed up how quickly we can run trials. That’s the job of our game-changing multi-arm, multi-stage trail, Octopus Octopus’ novel design will enable us to test multiple drugs at once, and add in new ones as soon as they’re discovered.
This blog was updated in April 2021 to reflect the latest information about the trials.