Outlining Areas of Unmet Need and Next Steps for Research in MS

Bruce Bebo, PhD

This is a 2-part interview. For part 1, click here.

Ongoing research in the field of multiple sclerosis (MS) is multifaceted, with experts not only working to identify additional disease-modifying approaches, but also responding to new data suggesting that Epstein-Barr virus (EBV) may be the leading cause for MS. Following the publication of findings in Jan 2022, the data have generated ongoing conversations and questions about future directions for research.¹

At the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, February 24-26, in West Palm Beach, Florida, Bruce Bebo, PhD, executive vice president, National MS Society, sat down with NeurologyLive^® to discuss his presentation on economic burden in the field, areas of unmet need, as well as his thoughts on the suggested relationship between EBV and MS.

According to Bebo, there is a need to establish effective DMTs for progressive forms of MS, as there has been “tremendous progress” for those with relapsing forms of the disease. Identifying at-risk patients earlier on is another area calling for more attention, he said, as implementing lifestyle and wellness strategies, or even disease modification, can be of assistance for those who may go on to develop MS. When it comes to EBV and MS, Bebo noted the biggest revelation from recent data was that it provided strong evidence against reverse causation, and the last step will be to prove causation via a prevention trial with a vaccine

NeurologyLive^®: Does your analysis include the costs of nonpharmacologic treatments/ wellness strategies? How might those impact what a patient is paying each year?

Bruce Bebo, PhD: Just this morning, in a session at the ACTRIMS meeting, [we] learned about the impact of comorbidities on MS—both the increase in comorbidities of people living with MS and the impact that comorbidities could have on the outcomes of MS. I feel like a lot of what we can accomplish with lifestyle and wellness activities is a reduction in the risk for some of these comorbidities that we are now [hearing about]—and heard this morning and have seen in the literature for years—that impact the rate of progression and of disease. I certainly think deploying, promoting a healthy lifestyle could, for some people, particularly [those] with progressive forms of MS, have an equal [impact].

Certainly, a major part of the therapeutic prescription, if you will, for MS should be a comprehensive approach to lifestyle and wellness, so indirectly reducing risk for comorbidities and managing comorbidities effectively, because we've seen how they interact [and are] intertwined with each other. I think that's a big place where lifestyle, wellness is and could have even more impact, and of course, [this could also help] employers, other organizations looking to increase people’s exercise, diet, wellness, in order to reduce the expense of providing health care for the populations that they serve. So, I do think that lifestyle, wellness activities have the potential of reducing the economic burden of MS, as well as all comorbidities associated with MS.

What do you feel are the areas of unmet need in the field of MS?

The greatest unmet needs are effective disease-modifying approaches to the progressive forms of MS. We've made tremendous progress in treatment of relapsing forms of MS and have a toolbox full of options for disease modification of [those] forms, but [there is] much, much more work to do in progressive forms of MS. So, I think that's where our biggest opportunity is.

To give you a second option, I do think this idea of being able to identify people at-risk for MS and either incorporating wellness-type activities, or even disease modification, if we get to the point where we can predict with some degree of confidence who will go on later to develop MS [is another area]. We know in other diseases like rheumatoid arthritis or Parkinson’s disease, there are ongoing clinical trials of prevention trials using biomarkers or algorithms to predict who might be at high risk for those diseases. I think we are getting closer to be able to do that for MS. I would call out those 2 things as the biggest areas of unmet need and where we [will], I think, see good progress in the next few years.

What are your initial thoughts on the recently published data linking EBV and MS?

So [there were] a couple of very interesting, exciting studies that are building on the case for EBV being a potential causal agent in MS. To me, the Brigham [and Women’s Hospital] study, that was published in Science, sort of confirmed prior observations around the temporal relationship between infection and onset of disease, but in my opinion, more importantly, it provided fairly strong evidence against reverse causation, which was, personally, my biggest concern around observations that had been made previously. I think they made a very strong case arguing against reverse causation, and I think where it takes us to is, we're still in this association phase, and we've got one last step to take in order to prove causation and that is some type of prevention trial with a vaccine.

We have been tracking and advocating at the Society for many years, the progress in this area and progress in vaccine development. We're excited about the possibility—there are some vaccine candidates, people certainly track Moderna’s news recently, but the NIH and others have been working on vaccines for a long time—it's a little bit more complicated than then [coronavirus] vaccine, unfortunately, but again, decades of research have been invested in developing vaccines for EBV, and there are some good candidates. So, we're very excited about that possibility, and I think we have been and will continue to advocate for and put resources to, ultimately testing prevention strategy, with EBV being probably the leading concept for prevention.

Transcript edited for clarity. For more coverage of ACTRIMS Forum 2022, click here.

REFERENCES
1. Bebo B, Cintina I, Yang W, et al. Economic burden of multiple sclerosis in 2019. Presented at ACTRIMS Forum 2022; February 24-26; West Palm Beach, FL and Virtual. Session CE3.1.
2. Bjornevik K, Cortese M, Healy BC, et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022;375(6578):296-301. doi:10.1126/science.abj8222