Mike talks to Professor Gavin Giovannoni about the results of two trials, specifically on upper body function.
Professor Gavin Giovannoni, Neurologist: There was lots of analysis of the Ocrelizumab in the primary progressive trial, and what was very interesting there is when you actually look at the effect of the drug on upper limb function, it was much greater effect, so almost 50% reduction in disability progression on upper limb, compared to 25% on lower limb. So this shows you that the more function you’ve got, the more reserve capacity to recover, the bigger the effect. So that was a real, real highlight.
Another highlight in progressive MS was the results of the ASCEND trial. This is a trial of natalizumab or Tysabri, it’s used in relapsing disease. It was trialling secondary progressive disease over two years, although the trial was negative, the impact on upper limb function was remarkable. It was positive. So this drug works in protecting upper limb function.
But we did an analysis at improvement in function and actually people on natalizumab improved, even though they had secondary progressive disease, compared to placebo. So I’m just hopeful that somebody in the regulatory environment will see that this drug works in secondary progressive MS and allow people to access the drug, particularly to protect upper limb function.
And we also presented data on a survey we did amongst people with the disease just showing you that they rate the upper limbs, much more important to them than the lower limbs. And you can understand why, I mean you can function in a wheelchair as long as your hands are working: typing, eating, buttons, you name it, taking tablets, injecting yourself, catheterising yourself, so all those functions that are really important for keeping people independent in the upper limb. And so we really would like to stress to the community that please, think hand, because hand function needs to become the new buzzword in MS because we should be focussing our attention on protecting upper limb function, and that was part of our… we had a campaign at ECTRIMS around that.
Mike:So we’re talking about upper limb functions, are there any particular strategies of people that are affected quite much in their upper areas that would be good for them to be able to do on a day-to-day basis?
Professor Gavin Giovannoni: Well, I mean we promote a healthy lifestyle, which includes exercise. Even if people are disabled in wheelchairs there are exercise programmes that they can do for upper limb function. I’m not going to tell them what it is because they probably need to get supervised initially by a physiotherapist, but they should still do exercise and almost certainly, people who do exercise do better in the long term than who don’t. And that exercise will include two functions: power, strength as well as dexterity tasks. So there’s lots of things they can do to exercise upper limbs. But I want them to get the message that even though they may have secondary progressive or primary progressive disease, the upper limbs can be modified. And so, I mean I hope, I just hope everybody understands how important these trials are, showing a much better impact of these drugs on upper limb disfunction. So that’s where we’ve got to go, we’ve got to do trials on these patients.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.