Measuring the effectiveness of treatments for multiple sclerosis (MS) is complicated; the disease biology is not entirely understood, and symptoms vary from person to person. While doctors and researchers continue to explore new endpoints for clinical trials that evaluate MS therapies, measuring relapse rates remains one of the most common.
Neurologist Enrique Alvarez, M.D., Ph.D., at the University of Colorado, Denver, discusses the importance of continuing to evaluate potential new therapies based on their ability to reduce relapse rates, along with newer measures that are bolstering these evaluations.
How do researchers measure the efficacy of new treatments for MS?
NEUROLOGIST ENRIQUE ALVAREZ, M.D., PH.D., AT THE UNIVERSITY OF COLORADO, DENVER, EXPLAINS WHY RELAPSE RATES HAVE REMAINED A BENCHMARK IN MS TRIALS.
Relapse rates are a benchmark for measuring the efficacy of new MS treatments in clinical trials. A relapse occurs when a new neurological symptom emerges or an old symptom gets worse for at least 24 hours. MS can cause a variety of symptoms such as vision loss, pain, fatigue or impaired coordination.
Signs of a relapse can be reported by the patient, and may have an immediate impact on the quality of a patients life. Relapse rates also tend to go hand-in-hand with disability rates; relapses are often associated with some lasting disability.
How else are researchers measuring efficacy in MS?
We have set criteria about how to determine a relapse, but these assessments are often subjective and can be noisy. This noise can be associated with a pseudo-relapse, which is the return of an old symptom because of factors unrelated to MS, such as stress, fever or an infection. MS symptoms can also fluctuate throughout the day, affecting a patients assessment.
The challenge is finding a way to measure clinical events across all the patients in a study. For example, how do you compare a patient who might have bladder function issues with a patient who has vision loss? That type of comparison remains a challenge.
These newer measurements are valuable, but we still need to look at relapse rates.
How are researchers overcoming the challenges of measuring efficacy in MS trials?
We have been including more objective, less noisy measures such as MRI [magnetic resonance imaging] metrics in trials. MRI measurements can serve as a substitute for clinical outcomes reported by patients.
In MS, the bodys immune system causes inflammation and damage in the brain, resulting in scar tissue, which we call a lesion. MRI can measure new and growing lesions in the brain. The more lesions a patient has, the more likely he or she will experience worsening symptoms and future relapses.
SECONDARY MEASUREMENTS SUCH AS MRI BRAINS SCANS CAN HELP MEASURE THE EFFICACY OF NEW MS TREATMENTS.
What are some newer measures that are being explored?
Newer measures are exploding. Were starting to see a host of cognitive testing measures. Balance is being evaluated more. There are kinetic measures, like those you can find on a smartphone app, to see how much the patient is walking. Were trying to get a sense of how the patient feels their life is changing on the tested therapy. You lose a little of the objectivity that you get with a measurement like MRI, but you gain a better sense of how the patient feels theyre doing.
Could these newer measurements replace relapse rates as a benchmark?
These newer measurements are valuable, but we still need to look at relapse rates. Rather than replace them, well be more likely to see combinations of multiple endpoints used to determine the efficacy of tested therapies in trials. The more measurements, the better.
To learn about how relapses can affect the lives of people living with MS, read World MS Day: MS Doesnt Stop Me from Living a Life I Love.
Read more:
MS Relapse Rates: Measuring MS Treatment Efficacy in ...
- Rally for Multiple Sclerosis Treatment Funding - May 7th, 2011 [May 7th, 2011]
- Breakthrough Multiple Sclerosis Treatment? - May 8th, 2011 [May 8th, 2011]
- Multiple Sclerosis Treatment - Mayo Clinic - May 11th, 2011 [May 11th, 2011]
- Tracy Macchia: Controversial MS Treatment - May 14th, 2011 [May 14th, 2011]
- What is Multiple Sclerosis - May 19th, 2011 [May 19th, 2011]
- MS Multiple Sclerosis treatment testimonial from Sanoviv Medical Institute - May 20th, 2011 [May 20th, 2011]
- Patient with progressive ms(paraplegia) Fmr treatment 1/4 - May 22nd, 2011 [May 22nd, 2011]
- New Jersey Multiple Sclerosis Treatment with Chiropractic Care - May 23rd, 2011 [May 23rd, 2011]
- MS Cure - Progression - June 2nd, 2011 [June 2nd, 2011]
- CCSVI UK Multiple Sclerosis Liberation Treatment - June 2nd, 2011 [June 2nd, 2011]
- Stem Cell Therapy MS: Sam Harrell and The Superbowl - June 3rd, 2011 [June 3rd, 2011]
- Holly Huber on Recovery: Stem Cell Therapy for Multiple Sclerosis Community Outreach Dallas, TX 2011 - June 8th, 2011 [June 8th, 2011]
- MS treatment sees early success - June 9th, 2011 [June 9th, 2011]
- CCSVI Possible cure for Multiple sclerosis - June 10th, 2011 [June 10th, 2011]
- MS Cure - Introduction to stem cell bone marrow transplant in Australia - June 11th, 2011 [June 11th, 2011]
- (Multiple Sclerosis Cure) Change Your Thinking? (Multiple Sclerosis Cure) - June 12th, 2011 [June 12th, 2011]
- Essiac cancer treatment herbal tincture, Ms Caisse...from The Secrets of Eden - June 12th, 2011 [June 12th, 2011]
- MS walking treatment breakthrough - June 14th, 2011 [June 14th, 2011]
- multiple sclerosis natural treatment | Kathy Canada Testimonial - June 18th, 2011 [June 18th, 2011]
- CCSVI Surgery India - Liberation Procedure Multiple Sclerosis Treatment in India - June 29th, 2011 [June 29th, 2011]
- XCell-Center MS CCSVI Liberation Angioplasty Treatment Results E.Schuurman 18_01_11 - July 1st, 2011 [July 1st, 2011]
- MS Cure - 7PM Project Carmel Turner MS Stem Cell Treatment - July 9th, 2011 [July 9th, 2011]
- MS Update! Tysabri or Gilenya? - July 10th, 2011 [July 10th, 2011]
- What causes BSE, CJD - July 15th, 2011 [July 15th, 2011]
- Kath Bartlett, MS, LAc Balance Method Acupuncture - July 16th, 2011 [July 16th, 2011]
- MS Cure - 730 report ben leahy carmel turner ms stem cell treatment - July 17th, 2011 [July 17th, 2011]
- CCSVI LIberation Treatment Tokuda - July 18th, 2011 [July 18th, 2011]
- FOX News Interview on the O'Reilly Factor - Treatment of Women in Islam - July 18th, 2011 [July 18th, 2011]
- CCSVI treatment bloopers holy crap - July 18th, 2011 [July 18th, 2011]
- Tarah's CCSVI Venoplasty. Dr McGuckin Explaining procedure findings - July 19th, 2011 [July 19th, 2011]
- Cancer Cure: The One-Minute Cure For Cancer, MS - July 24th, 2011 [July 24th, 2011]
- Not Ready to Cheer CCSVI Trials - July 29th, 2011 [July 29th, 2011]
- New Oral Treatment for MS - July 30th, 2011 [July 30th, 2011]
- 27/07/2011 - MS patients seek controversial treatment - August 1st, 2011 [August 1st, 2011]
- MS Cure - 11 I am still walking - August 5th, 2011 [August 5th, 2011]
- Upcoming Treatments for MS - Pt 1 -MSRA Public Lecture - Dr Suzanne Hodgkinson - August 10th, 2011 [August 10th, 2011]
- Stem Cells for MS Community Outreach: Patient Judi Lecoq - Dallas, TX 2011 - August 18th, 2011 [August 18th, 2011]
- Stem Cell Treatment for Multiple Sclerosis - Community Outreach, San Diego: David Oliver - August 19th, 2011 [August 19th, 2011]
- New Study Tests Possible Treatment for MS - August 25th, 2011 [August 25th, 2011]
- Professor Dimitrios Karussis: Treating MS - August 26th, 2011 [August 26th, 2011]
- walking with MS before CCSVI treatment.wmv - August 27th, 2011 [August 27th, 2011]
- Suzy Cohen Discusses The Liberation Treatment for MS - September 14th, 2011 [September 14th, 2011]
- Multiple Sclerosis MS People - Amazing New Treatment - September 15th, 2011 [September 15th, 2011]
- Multiple Sclerosis Alternative Treatment - September 17th, 2011 [September 17th, 2011]
- CLEAR scoliosis treatment, Dr. Culpepper (MS) - September 22nd, 2011 [September 22nd, 2011]
- Liberation treatment for MS - September 23rd, 2011 [September 23rd, 2011]
- 44b - My Lyme disease and rheumatoid arthritis journey - Miraculous CCSVI treatment for MS sufferers - September 24th, 2011 [September 24th, 2011]
- A Closer Look at Gilenya - The First Oral Treatment for MS - September 28th, 2011 [September 28th, 2011]
- Unequal Treatment Drives Disability Rights Movement - September 28th, 2011 [September 28th, 2011]
- Multiple Sclerosis - The Nebraska Medical Center - September 29th, 2011 [September 29th, 2011]
- Testimonial for CCSVI Treatment Excel Heart Center Mexico -- Tanya Reay - September 30th, 2011 [September 30th, 2011]
- Current thinking on what causes MS - Pt 1 - MSRA Public Lecture -Prof Graeme Stewart - October 2nd, 2011 [October 2nd, 2011]
- Current and emerging therapies in MS - Part 02 (How do these treatments work?) - October 2nd, 2011 [October 2nd, 2011]
- MS Richard Humphries before and after treatment for Multiple Sclerosis with stem cells - October 3rd, 2011 [October 3rd, 2011]
- Matthew - CCSVI and his Liberation Treatment - October 8th, 2011 [October 8th, 2011]
- Multiple Sclerosis - Myelin Repair - Video - October 14th, 2011 [October 14th, 2011]
- MS Auto Immune vs CCSVI Treatment Simple Pictures by Berukoff - Video - October 23rd, 2011 [October 23rd, 2011]
- New Promising Treatment for Those Living with Multiple Sclerosis - Video - October 29th, 2011 [October 29th, 2011]
- Stem cells to treat MS - Pt 2 - MSRA Public Lecture - A/Prof Richard Burt - Video - October 30th, 2011 [October 30th, 2011]
- New hope for treating multiple sclerosis - Video - October 31st, 2011 [October 31st, 2011]
- CCSVI Multiple sclerosis Breakthrough/cure - Video - October 31st, 2011 [October 31st, 2011]
- Inhuman Treatment of Wheelchair bound Multiple Sclerosis Patient in Canadian Care Home - Video - November 9th, 2011 [November 9th, 2011]
- MS treatment movie Cells4health.mp4 - Video - November 10th, 2011 [November 10th, 2011]
- Racing to the Cure for MS: Myelin Repair Foundation Celebrates MS Awareness Week - Video - November 12th, 2011 [November 12th, 2011]
- [Symptoms of Multiple Sclerosis] - Video - November 12th, 2011 [November 12th, 2011]
- Multiple Sclerosis Treated with Adult Stem Cells - Video - November 13th, 2011 [November 13th, 2011]
- Stem cells to treat MS - Pt 1 - MSRA Public Lecture - A/Prof Richard Burt - Video - November 16th, 2011 [November 16th, 2011]
- Multiple Sclerosis A Natural Treatment - Video - November 16th, 2011 [November 16th, 2011]
- My MS and Stem Cell Treatment - Video - November 16th, 2011 [November 16th, 2011]
- CCSVI Liberation News Reports - Video - November 20th, 2011 [November 20th, 2011]
- Stem Cells for MS Community Outreach: Patient Sam Harrell - Dallas, TX 2011 - Video - November 21st, 2011 [November 21st, 2011]
- Arthur S13 E2-1 - The Silent Treatment - Video - November 27th, 2011 [November 27th, 2011]
- Holly Huber on Recovery: Stem Cell Therapy for Multiple Sclerosis Community Outreach San Diego CA - Video - December 3rd, 2011 [December 3rd, 2011]
- CCSVI - Video - December 3rd, 2011 [December 3rd, 2011]
- My Sister's Experience with Liberation Treatment for Multiple Sclerosis PART 2/2 - Video - December 5th, 2011 [December 5th, 2011]
- Multiple Sclerosis -- Treatment LDN story - Video - December 7th, 2011 [December 7th, 2011]
- ABC News - Multiple Sclerosis effectively treated by a new acoustic medical device. - Video - December 9th, 2011 [December 9th, 2011]
- MS Patient After Stem Cell Therapy - Video - December 10th, 2011 [December 10th, 2011]
- Multiple Sclerosis - Video - December 12th, 2011 [December 12th, 2011]
- Journey of Connective Tissue, Autoimmune disease, steroid treatment updates. - Video - December 22nd, 2011 [December 22nd, 2011]