Source The Lancet: Neurodegeneration is the pathological substrate that causes major disability in secondary progressive multiple sclerosis. A synthesis of preclinical and clinical research identified three neuroprotective drugs acting on different axonal pathobiologies. We aimed to test the efficacy of these drugs in an efficient manner with respect to time, cost, and patient resource.

Methods

We did a phase 2b, multiarm, parallel group, double-blind, randomised placebo-controlled trial at 13 clinical neuroscience centres in the UK. We recruited patients (aged 25–65 years) with secondary progressive multiple sclerosis who were not on disease-modifying treatment and who had an Expanded Disability Status Scale (EDSS) score of 4·0–6·5. Participants were randomly assigned (1:1:1:1) at baseline, by a research nurse using a centralised web-based service, to receive twice-daily oral treatment of either amiloride 5 mg, fluoxetine 20 mg, riluzole 50 mg, or placebo for 96 weeks. The randomisation procedure included minimisation based on sex, age, EDSS score at randomisation, and trial site. Capsules were identical in appearance to achieve masking. Patients, investigators, and MRI readers were unaware of treatment allocation. The primary outcome measure was volumetric MRI percentage brain volume change (PBVC) from baseline to 96 weeks, analysed using multiple regression, adjusting for baseline normalised brain volume and minimisation criteria. The primary analysis was a complete-case analysis based on the intention-to-treat population (all patients with data at week 96).  Read on. 

Source MS Society: This week the European Medicines Agency (EMA) granted a license for siponimod (brand name Mayzent) to treat adults with secondary progressive MS with active disease.

That makes siponimod the first and only oral treatment in Europe specifically for patients with secondary progressive MS with active disease.

What was the evidence?

The drug approval is based on the Phase III EXPAND trial, the largest randomised clinical study of people with secondary progressive MS.

This trial showed taking siponimod significantly reduced the risk of disease progression, including physical disability and cognitive effects.

Who can have siponimod (Mayzent)?

Siponimod hasn’t been recommended for everyone with secondary progressive MS. It’s only been recommended for people who have evidence of inflammatory activity on an MRI scan or who still have relapses.  Read on.

Source BBC: One in two people who appealed in court against a decision to deny them disability benefits were successful, analysis of five years of data shows.

In total, more than 550,000 people won an appeal over their benefits at tribunal between 2013 and 2018.

Ann Barker, who has bipolar disorder, said she was tempted to give up, but had twice fought a decision at tribunal and won.

The government said only around 5% of disability decisions were overturned.

Benefits assessments are carried out on behalf of the Department for Work and Pensions (DWP) by the private contractors Capita, the Independent Assessment Services (formerly called Atos) and Maximus.

The success rates showed benefits assessments were beset by “poor decision-making” and “obvious inaccuracies”, charities said.

In 2018, the Commons Work and Pensions Committee said failings in disability benefits assessments had led to a “pervasive lack of trust” in the system. It said ministers should consider taking the process back in-house.  Read on.

Source MS Society: Virtual reality, wearable robots and magnetic brain stimulation. Technology is at the forefront of 13 new research projects we’ve just announced.

Each year we run a competition to choose the best MS research projects from across the UK. This year we’ve committed to raise £1.3 million to fund 13 exciting new research projects.

The projects include research on MS progression, and studies exploring new technologies to manage MS symptoms.  Read on.