What would you say are the real hurdles that researchers face with regard to this? It’s just such a broad thing, like you were saying there’s no definitive way to say, you know, we can’t say… we can do all these tests but there’s no clear way to say okay, we can say in this many years this is what’s going to happen. You may not be able to walk, you may be in a wheelchair, you maybe lost mobility, you know, it’s just individual’s difficult, so it’s quite a different thing to… you know, it’s quite difficult.
Yeah, yeah, yeah. I mean everybody is different. There are probably genetic factors that we don’t understand that govern the severity of the disease and, you know, whether we will find a biomarker that correlates with that severity, I really don’t know. But it’s, you know, I mean the reality is when you deal with multiple sclerosis lots, it is such a heterogeneous disease, you know, I mean its manifestations are so broad and so varying, you know, even within individuals. You know, you see periods of great activity in somebody, followed by periods of inactivity, for years sometimes. And so, you know, being able to predict what’s going to happen in each individual I think is going to require, you know, much more individual patient information, very closely followed over decades, you know. And this is one of the problems, you know, a lot of the science that’s done in multiple sclerosis is done over quite short term time periods and the reality is that what matters is the long term, you know? You know, often it’s not the short-term activity that leads to disability, it’s the decades.
Yeah. Thank you. Interesting, I’m within this band, so to speak. How close are we in predicting disease progression in people with relapsing remitting MS?
The degree of disease progression, I think, you know, not terribly close on an individual level, you know. I think that there are markers that we can see in early disease that can help us. So high lesion loads, loss of brain tissue on the brain scan leading to atrophy, high relapse numbers in the early years, relapses with incomplete recovery. And there are biomarkers that we think may be useful, that correlate with these factors that I’ve just mentioned, such as neurofilament that might add into that. So I think that we can broadly say that there are prognostic factors that help us. But all of the, you know, if you think about this, what we’re saying is, I see you in the clinic, we look at your disease to date, and we’re trying to use the past to predict the future. And the reality is that sometimes that’s not such a perfect predictor, you know. What we need is better studies looking at people right at the beginning of their disease, looking at all sorts of factors, biomarkers, genomic factors, transcript genomic factors, MR factors, that, you know, and then follow these people over long periods of time so that we can establish those features right at the beginning of the disease that might predict the long term. You know, we have some predictors but they’re not reliable enough for us to give an individual an accurate prognosis.
And that, you know, that’s so important, because the decisions we’re making are for individuals, we’re not making them for groups, this isn’t a clinical trial, we’re trying to do what’s best for the person in front of us and, you know, basing it on the past and accepting that there is this big degree of uncertainty makes it hard to make those individual decisions, you know. And people with MS really struggle with this, I can tell you their doctors really struggle with this, I mean their doctors agonise over whether they should go on drug X or drug Y or do this or do that, because truly, what everybody wants is to know what the future holds for that individual and, they don’t.
Yeah, we don’t know. We just have to do all the things we should do to make as best as we can. Fantastic.
Dr Overell works at the Glasgow MS clinical research centre. He gained his MD from Edinburgh Medical School in 1994. Scotland has the highest rate of MS in the world as such the Glasgow centre is one of the largest in the world. He is currently leading a major UK-based observational study examining the use and safety of new monoclonal therapies.