Chris asks Professor Alan Thompson about the disease modifying treatments affect disease progression.
Chris: How do new range of DMTs available that reduce relapse rate affect disease progression?
Professor Alan Thompson, Neurologist: The long term.
Professor Alan Thompson:I think that’s another really difficult question.
Chris: How long’s a piece of string?
Professor Alan Thompson: Well, I mean you know, because that speaks to the very heart of MS, so we know that it’s an inflammatory condition, but we also know that there’s neurodegeneration. We don’t really understand the relationship between inflammation and neurodegeneration, but current drugs that we have have an effect on inflammation and they work well and best early on in the condition. And the big question is, if you do suppress inflammation early on, does that have an impact on the neurodegeneration that is occurring. And that neurodegeneration is occurring right from the beginning, it’s not something that happens just in 20 years’ time, it happens, you can see it very early on. And nobody knows the answer to that, because we don’t know the relationship between the two. Intuitively you would think, well, if you’re supressing inflammation surely it will have an effect on neurodegeneration and on subsequent progression. But the trial evidence is very light, is the best word, because if you want to follow up people at ten, 15, 20, 30 years to see the effect, of course most people have dropped out of those trials, have gone on to other drugs, and the people that have stayed on those medications are people that have seen benefit from them, so it’s a highly selected, usually very small population and it’s difficult to say. There is probably an effect, but it’s probably a small effect, would be my guess. But I don’t think we have the robust evidence to answer that question emphatically either way.
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