A figure from our latest paper: Daruwalla C….. Brown JWL. Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting multiple sclerosis. Mult Scler. 2023 Feb 27 available here.

 

The Brown Group uses Big Data to reduce disability in multiple sclerosis, one of the most common causes of disability in the young. We have three research themes to achieve this:

Optimising the use of existing disease-modifying therapies

More than 20 disease-modifying therapies are licensed in multiple sclerosis. But we don’t know how best to use them. Growing evidence suggests the greatest effect from the strongest treatments when used in the first few years (e.g. Brown et al JAMA 2019), even in those with non-disabling relapses (e.g. Daruwalla et al MSJ 2023). We now want to personalise treatment for people with MS: which drug, when and for how long. We are currently studying the prognosis and optimal management of clinically silent activity on MRI scans; whether commencing treatment at the very earliest stages confers additional benefit; how to manage disease breakthrough on higher-efficacy therapy; and when we can safely stop therapies.

Randomised controlled trials remain the gold standard for proving causality. Through collaboration with two international statistical authorities – Professors Jonathan Sterne (Bristol) and Tomas Kalincik (Melbourne) – we prove causality by emulating clinical trials to mitigate confounding and selection bias.

Transforming existing registries using IT

To answer these crucial questions about optimising treatments, we use registries containing ‘real-world’ data collected from clinics. But reliable answers need reliable data. And lots of it. Registries currently contain clinical data from <1% of people in the UK with multiple sclerosis.

We are resolving this. We are transforming the existing software used in clinics so that data is automatically and securely sent to registries after every clinic encounter in those that consent. This will also enhance safety and efficiency in clinics. All without any additional time for busy doctors and nurses.

And we have created a national consent form enabling people with neuroimmunological conditions (such as MS) to sign up to 4 different types of research from the comfort of their own home (CONSENTOR). This includes participation in multiple registries, different types of local research and a new trial eligibility checker which informs them when they become eligible for a new trial. This will go live in early 2024.

Using big data to personalise future repair therapies

Repair therapies – particularly those promoting remyelination – will reach the clinic in the next few years. We must understand who needs them, when to start them and for how long they should be taken. And we must be able to reliably measure their effects. Working with the wider Cambridge Clinical MS team, we are ensuring registries have sufficient clinical, MRI and visual evoked potential data to enable these questions to be answered once these therapies arrive.