The clinical perspective: How to personalise treatment in MS and how may biomarkers including imaging contribute to this?

Abstract

Background: Multiple sclerosis (MS) is a highly heterogeneous disease, both in its course and in its response to treatments. Effective biomarkers may help predict disability progression and monitor patients' treatment responses. Objective: The aim of this review was to focus on how biomarkers may contribute to treatment individualisation in MS patients. Methods: This review reflects the content of presentations, polling results and discussions on the clinical perspective of MS during the first and second Pan-European MS Multi-stakeholder Colloquia in Brussels in May 2014 and 2015. Results: In clinical practice, magnetic resonance imaging (MRI) measures play a significant role in the diagnosis and follow-up of MS patients. Together with clinical markers, the rate of MRI-visible lesion accrual once a patient has started treatment may also help to predict subsequent treatment responsiveness. In addition, several molecular (immunological, genetic) biomarkers have been established that may play a role in predictive models of MS relapses and progression. To reach personalised treatment decisions, estimates of disability progression and likely treatment response should be carefully considered alongside the risk of serious adverse events, together with the patient's treatment expectations. Conclusion: Although biomarkers may be very useful for individualised decision making in MS, many are still research tools and need to be validated before implementation in clinical practice.

The payer’s perspective: What is the burden of MS and how should the patient’s perspective be integrated in health technology assessment conducted for taking decisions on access to care and treatment?

“…Clinically, MS is characterised by multiple signs and symptoms of neurological dysfunction, including gait and mobility impairment, spasticity, visual and sensory disturbances, bladder and bowel problems, pain, sexual disturbances, fatigue, cognitive deterioration and depression. 2,9 The Atlas of MS is an extensive worldwide survey of the epidemiology of MS and the global availability and accessibility of resources for people with MS, performed by the Multiple Sclerosis International Federation (MSIF). The 2013 data revealed sensory (40%) and motor (39%) symptoms as the most common, and pain (15%) and cognitive issues (10%) as the least common symptoms ( Figure 1).…”

“…The 2013 data revealed sensory (40%) and motor (39%) symptoms as the most common, and pain (15%) and cognitive issues (10%) as the least common symptoms ( Figure 1). 8,9 Although the range of MS-related Natural course of relapsing-remitting multiple sclerosis. In all, 85% of patients with MS have a biphasic disease course.…”

Conclusions: Calls to action for improving the life of MS patients and their families

“…Moreover, it was considered crucial to use the same standardised protocol as well as the same MRI machine in one patient during follow-up/over time. 6 In addition, there is need for fully automated pipelines for measuring and analysing MRI outcomes, which should be integrated in all major MRI vendors' post-processing software and allow transfer of information into a picture archiving and communication system (PACS). 6 Also the reports of MRI results from radiologists to neurologists should be standardised and combined with the conventional (written) report.…”

“…6 In addition, there is need for fully automated pipelines for measuring and analysing MRI outcomes, which should be integrated in all major MRI vendors' post-processing software and allow transfer of information into a picture archiving and communication system (PACS). 6 Also the reports of MRI results from radiologists to neurologists should be standardised and combined with the conventional (written) report. 6 Certification of centres and (neuro)radiologists fulfilling minimum technical/MRI machine requirements who have adequate quality control programmes and standardised protocols in place by ECTRIMS or ESNR may help to accelerate standardisation.…”

“…6 Pharmacogenomics studies may identify genetic variants predicting response to DMDs. 6 When this will result in giving the right treatment to the right patient at the right time considerable improvements in the quality of care and cost-savings can be made. Therefore, the EU should increase funding allowing further development and validation of functional and structural biomarkers including molecular biomarkers such as CHI3L1 and NFs.…”