AttackMS was conceived on the 29th of Nov 2017 over a beer or two (or was it Elderflower?) at the Lago Maggiore.
Prof Jeremy Hobart (Plymouth), ProfG and I sat down on the eve of the annual meeting of the European Charcot Foundation in Baveno, and I said something along the lines of: “Why don’t we treat MS with highly effective disease modifying treatment (HE-DMT) at first presentation, which means potentially even *before* the McDonald criteria of MS (free download available here) are fulfilled? A: Mostly because of diagnostic uncertainty. However, if we can be ≥80% certain at first presentation that MS is the diagnosis, the main reasons not to treat with HE-DMT are (i) long term effects of the treatment on the immune system in case the diagnosis does not turn out to be MS and (ii) potentially detrimental effects of the HE-DMT on one of the possible differential diagnoses. So what about using N a t a l i z u m a b ?”
We ordered another beer (or was it Elderflower?).
However, waking up next morning we knew that – bar preventing MS altogether (and aren’t we all excited about the latest news about EBV?) – AttackMS may provide the most promising risk/benefit compromise here and now to explore whether intervention with HE-DMT within 14 days of symptom onset is feasible and can facilitate brain lesion repair (remyelination).
We discussed the concepts underpinning AttackMS with people who were recently diagnosed with MS. Their feedback was very positive, and I’m delighted that Rachel and John have joined the team as PPI members.
Key question then was, which biomarker should we use as the primary outcome, and after some toing and froing about serum neurofilament light chain level we decided that lesion MRI magnetization transfer ratio (MTR) it would be. MTR has been in use for some time in phase II MS trials of myelin repair, most recently in the Bexarotene study. Vanity strikes when I tell you our investigation of the pathological correlates of MTR in MS (main correlate: myelin) remains my highest cited paper…
Funding was obviously also needed, and we were fortunate that Biogen, the maker of natalizumab (Tysabri®), awarded the amount required to undertake the study, which is now due to start recruitment, under the sponsorship of QMUL, from March/April, i.e. in 2-3 months.
Please be aware AttackMS is NOT OPEN FOR RECRUITMENT YET. WE WILL KEEP YOU UPDATED!
The slides give an overview of the study. Recruitment will be challenging, and we’ll undertake plenty of awareness activities, mainly among acute physicians and neurologists involved in acute medical care in and around London, though essentially anybody up to age 45 in the UK presenting within 14 days of symptom onset and an MRI suggestive of demyelination has a chance to join AttackMS. They just need an acute referral to one of our three trial sites Chelsea & Westminster (PI: Dr Victoria Singh-Curry), St George’s (PI: Dr Waqar Rashid) and The Royal London (PI: ProfK).AttackMS_overview_20220129
Disclaimer: The opinions expressed here are those of the author and nobody else.
CoI: I am the CI of AttackMS, which is an investigator initiated and led study sponsored by Queen Mary University of London, and funded by Biogen.