A new world-first method to help doctors predict which patients are at risk of developing an aggressive form of multiple sclerosis has been uncovered.
The findings by Melbourne researchers will make it easier to work out which MS patients need urgent access to powerful drugs to prevent or delay disease progression.
It comes as a new study reveals that receiving highly effective treatments earlier can significantly reduce long-term disability.
More than 25,000 Australians have the chronic disease, which occurs when the body’s immune system destroys the outer protective layer of nerves, disrupting signals to the brain.
MS can affect movement, sensation and cognition.
In a new study, the Royal Melbourne Hospital and University of Melbourne team identified three clinical markers, which indicate a patient has a high risk of developing aggressive MS. This form of the disease results in early and rapid disability.
The study published in the journal Brain found patients who had a significant deterioration in their symptoms in the first 12 months, were older than 35 at disease onset, and displayed certain movement dysfunction were most at risk.
The research led by Dr Charles Malpas, from the University’s Clinical Outcomes Research unit (CORe), found those patients who had all three markers had a very high risk.
Associate Professor Tomas Kalincik, head of the RMH’s MS Centre and CORe said the markers were a simple and cost-effective way to help guide treatment choices.
“With the current MS medications, we can prevent many symptoms and a lot of irreversible damage to the brain and the spinal cord,” A/Prof Kalincik said.
Currently, powerful therapies, which have a higher risk of side-effects, are usually not used as frontline treatment.
MS patients receive moderate-efficacy low-risk medication until their disease progresses, which is when doctors switch to intense therapies.
“These clinical markers will help improve our ability to detect the patients who need higher efficacy treatment earlier with more precision,” he said.
A world-first second study, led by CORe researcher Dr Anna He, highlights the potential benefits of giving patients potent drugs earlier.
The research published in The Lancet Neurology journal revealed that patients who received these medications within two years of diagnosis had less disability up to 10 years later, than those who started treatment 2 to 4 years later.
“We are proposing that highly potent therapies should be considered as first-line choice in patients with active relapsing-remitting MS at risk of developing aggressive disease,” A/Prof Kalincik said.
Both studies were observational studies using data from MSBase, the world’s largest international MS registry and the Swedish MS Registry.
The next step is to use the clinical markers to determine at-risk patients and test whether giving them early access to powerful medications can improve outcomes.
Deanna Tabacco was diagnosed with MS six years ago when she was just 22 years old.
The condition impacted her vision, “I woke up from a nap and I couldn’t see properly out of my eye, I didn’t know if I had something in my eye, but my optometrist thought there were some similarities with other cases of MS,” Deanna said.
After that I presented at the RMH and was given my first treatment which helped get my vision back.
Around three months later I had follow up MRI scans and it was confirmed I had MS.
“These studies are great step forward, this will help lots of people get better outcomes when they are diagnosed,” Deanna said.
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