Preventing disability in patients with severe forms of MS

Dr Izanne Roos

University of Melbourne

| Better treatments | Neurobiology | Fellowship | 2022 | Investigator Led Research |
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Summary

MS is a prominent cause of neurological disability. The course of MS is different for each individual, with approximately 6% of people have an aggressive form of MS and accumulating disability at a faster rate.    

Preventing disability is a primary goal of MS treatment. More than 13 treatments with varying potency and safety have been registered for MS in Australia. Treatment choices should be personalised, and the right treatment should be used for each person to optimise long-term outcomes. Currently, however, the best treatment approach in people with aggressive MS remains uncertain.   

In this research project, Dr Izanne Roos will first confirm the reliability of statistical models that predict an individual’s risk of developing aggressive MS at the earliest stages of MS.    

The team will then establish whether early use of highly potent therapies can prevent aggressive disease in those at high risk. This will be analysed in data from two large MS registries.   

Finally, the study team will generalise these findings to the MS population, by testing whether early use of highly potent therapies can prevent disability, using data from two clinical trials and another large clinical study. This will provide conclusive evidence to confirm if early use of high potency therapy can prevent disability in a broader population of people with MS.   

Progress to Date

Using statistical modelling, Dr Roos and her team validated a model previously developed in Spain that creates individualised predictions for the 10-year risk of eight relevant MS milestones regarding relapses, MRI activity and disability and accumulation. This model can be used in the future to gauge an individual’s future risk of disease severity. 

Dr Roos and her team have also studied the effectiveness of high-efficacy therapies in people with MS who are at the highest and at the lowest risk of developing disability. The team found that high-efficacy therapies reduce the risk of relapse and disability accumulation in all people irrespective of their risk of aggressive MS. This emphasises the importance of high-efficacy therapies in improving outcomes in people with MS. 

Over the next 12 months, Dr Roos and her team will complete the analyses on optimal treatments for people with MS and the highest and lowest risks of developing disability. These analyses will look at the risks of relapse and worsening of disability and the effects of timing of treatment.

Publications

  • Roos I, Diouf I, Sharmin S, et al. Comparative effectiveness in multiple sclerosis: A methodological comparison. Multiple Sclerosis Journal. 2023;0(0). doi:10.1177/13524585231151394 
  • Roos I, Malpas C, Leray E, et al. Disease Reactivation After Cessation of Disease-Modifying Therapy in Patients With Relapsing-Remitting Multiple Sclerosis. Neurology. Oct 25 2022;99(17):e1926-e1944. doi:10.1212/WNL.0000000000201029] 
  • Malpas C, Roos I, Sharmin S, et al. Multiple sclerosis relapses following cessation of fingolimod. Clinical Drug Investigation 2022 Apr;42(4):355-364. 
  • Frascoli F, Roos I, Malpas CB, Kalincik T. The dynamics of relapses during treatment switch in relapsing-remitting multiple sclerosis. J Theor Biol. 2022 May 21;541:111091. doi: 10.1016/j.jtbi.2022.111091. Epub 2022 Mar 11. PMID: 35283184. 
  • Diouf I, Malpas CB, Sharmin S, Roos I, et al. Effectiveness of multiple disease-modifying therapies in relapsing-remitting multiple sclerosis: causal inference to emulate a multiarm randomised trial. J Neurol Neurosurg Psychiatry2023;94(12):1004-11. 
  • Roos I, Hughes S, McDonnell G, et al. Rituximab vs Ocrelizumab in Relapsing-Remitting Multiple Sclerosis. JAMA Neurol. Aug 1 2023;80(8):789-797. doi:10.1001/jamaneurol.2023.1625 
  • Kalincik T, Sharmin S, Roos I, et al. Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis. JAMA Neurol. Jul 1 2023;80(7):702-713. doi:10.1001/jamaneurol.2023.1184 
  • Diouf I, Malpas CB, Sharmin S, Roos I, et al. Variability of the response to immunotherapy among subgroups of patients with multiple sclerosis. Eur J Neurol. Apr 2023;30(4):1014-1024. doi:10.1111/ene.15706 
  • Aboseif A, Roos I, Krieger S, et al. Leveraging Real-World Evidence and Observational Studies in Treating Multiple Sclerosis. Neurol Clin 2024;42(1):203-27. 
  • Kalincik T, Roos I, Sharmin S, Malpas CB. Methodological considerations for observational studies of treatment effectiveness in neurology: a clinician's guide. J Neurol Neurosurg Psychiatry. Oct 27 2023;doi:10.1136/jnnp-2022-330038 
  • Kalincik T, Roos I, Sharmin S. Observational studies of treatment effectiveness in neurology. Brain. Aug 172023; doi:10.1093/brain/awad278 

Updated 31 March 2024 

Updated: 14 February, 2022

Stages of the research process

Fundamental laboratory
Research

Laboratory research that investigates scientific theories behind the possible causes, disease progression, ways to diagnose and better treat MS.

Lab to clinic timeline: 10+ years
Translational
Research

Research that builds on fundamental scientific research to develop new therapies, medical procedures or diagnostics and advances it closer to the clinic.

Lab to clinic timeline: 5+ years
Clinical Studies
and Clinical Trials

Clinical research is the culmination of fundamental and translational research turning those research discoveries into treatments and interventions for people with MS.

Lab to clinic timeline: 1-5 years

Investigator

Co-investigator

  • Professor Tomas Kalincik

Grant Awarded

  • Postdoctoral Fellowship

Total Funding

  • $225,000

Duration

  • 3 years

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Lachlan Rash

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Preventing disability in patients with severe forms of MS