June Halper: Better Screening for PPMS

Much focus on primary progressive multiple sclerosis (PPMSS) care fixates on improved care. Presently, just ocrelizumab (Ocrevus) has been approved to treat the persistent, rare for of the neurological condition, and most common MS therapies miss the mark in patients with PPMS.

But screening methods could also be improved. In an interview with MD Magazine®, June Halper, MSN, APN-C, chief executive officer of the Consortium of Multiple Sclerosis Centers (CMSC), discussed the importance of early PPMS diagnosis, and what other indicators may clinicians better gauge in order to know when is best to initiate therapy.

MD Mag: Does screening need to improve for primary progressive MS?

Halper: Probably. I would say just talking to people at our meeting last week, there was some discussion: “Is there a screening window for ocrelizumab?” And we really don't know.

Like I said: in relapsing forms of MS, we now know—because there's been some studies—that the earlier you treat the patient, the better their response. And we don't have that kind of study yet in PPMS. My opinion is to hit them, treat them immediately. But on the other hand, sometimes it takes a couple of years to diagnose that person because that person might start out looking like relapsing MS, but then suddenly start progressing, and there is no cut-off where you say, “A-ha, it’s progressive MS.”

So it's sometimes very difficult to be able to say from day 1, that person is going to have a progressive course. They treat everybody like relapsing, and I'm hoping that there may be some biomarker which they're looking into now, to see if maybe light change may be more predictive of progression. Or, maybe sometimes, like a blood test or maybe some spinal fluid indicators—something will say, “This person is not relapsing, get them on something for progression.”

We don't have that yet.

Does that mean inflammation needs to be better screened in patients?

That's exactly it. They treat it what they treat all MS like MS, and they treated as if it's inflammatory. And one of the other things we learned about 10 years ago: everybody always said that people with PPMS never had enhancing lesions.

There was a study called the PROMISE trial with Copaxone, and that trial showed when they did MRIs that these people with PPMS had enhancing lesions. So of course if you have an enhancing lesion at the time of diagnosis, you treat them like they are belong on the DMT for inflammatory disease.

So again, I think biomarkers are going to be the real answer on how to differentiate between active and inactive, and PPMS versus relapsing form.