On a global level, there is a concerning gap between the results of clinical trials and regulators' approval of advanced therapies, leaving some individuals with multiple sclerosis (MS) without access to the most effective options. Therapeutic lags have resulted in entire regions where individuals with MS will be disabled for longer, due to restrictions or lags in regulatory approvals that restrict doctors from prescribing treatments with the best outcomes.
"Few neurological conditions have seen advancements like that in the study of MS," says professor Alan Thompson, FMedSci, FRCP, FRCPI, chair SSC of the International Progressive Alliance. "MS has gone from being an untreatable condition to being a manageable disease which is an extraordinary story of achievement, but there is still a long way to go."
"The understanding of the disease and disease phenotypes are changing," said Prof. Bill Carroll, president of the World Federation of Neurology (WFN) and neurologist at the Department of Neurology and Neurophysiology at the Sir Charles Gairdner Hospital in Perth, Western Australia. "We have found that drugs do modify the disease, and the underlying disease process matches poorly with these outdated clinical phenotypes."
To see improved developments in MS treatment and diagnosis, global awareness, and advocacy are in order. "International initiatives and awareness will help unlock greater funding for MS research and lead to more effective treatments," says Thompson.
The new research was unveiled on pregnancy and MS by professor Mar Tintore, MD, PhD, the clinical chief of neurology in the Neurology-Neuroimmunology Department at the Multiple Sclerosis Centre of Catalonia at the Hospital Vall d'Hebron. Through her research, Prof. Tintore found that how data is analyzed can lead to a misunderstanding of whether pregnancy can impact the long-term prognosis of MS, a shift from earlier studies about the interaction between pregnancy and MS.
"Comparing women who had any pregnancy during their disease with women who had not experienced pregnancy during their disease, what you see is that women with pregnancy are better off than those who had never been pregnant," says Prof. Tintore. "This is not exactly the case when you consider other factors, which makes it likely that pregnancy doesn't change the trajectory of the disease."
Pregnancy may not modify the course of the disease long-term prognosis, but research shows that there is an impact on short-term prognosis. Other factors play an important role in MS such as an individual’s age, gender, baseline lesions, and if they are on treatment and for how long.
"To advertise that pregnancy has a very important impact and will positively modify your long-term prognosis is something we must be cautious about because studies show it is not true," says Prof. Tintore. "It could cause patients to think pregnancy can replace treatment and may cause confusion for providers who think pregnancy would treat the disease."
Melissa W. Ko, MD; Kevin E. Lai, MD; and Devin D. Mackay, MD
Chen Zhao, MD; Claire Flaherty, PhD; Paul J. Eslinger, PhD; and Krishnankutty Sathian, MBBS, PhD