Predictors for Personalized Multiple Sclerosis Treatment

Novel Multiple Sclerosis Studies Define Predictors of Prognosis to Personalize Treatment for Patients

Neurologists at Brigham and Women's Hospital (BWH) are using data captured by devices (such as sensors and smartphones), biologic profiling, clinical imaging, and neurologic examinations, in research studies designed to pinpoint factors that may determine an individual's course of disease and to tailor treatment options that have not been previously available to patients.

"Our goal is to individualize care for each MS patient, but we don't currently have any reliable way to predict which patients will respond to a specific treatment, as well as which patients have disease that will progress quickly and requires aggressive therapy," said Howard L. Weiner, MD, Director of the Brigham Multiple Sclerosis Center and Co-director of the Ann Romney Center for Neurologic Diseases at BWH. "By compiling vast amounts of new information, combined with existing data from our ongoing studies, we are developing a deep phenotyping of the MS patient, enabling us to gain an understanding of this disease in a way that we've never been able to achieve in the past."

Collaboration Uses Wearables to Enable Robust Measurements

Dr. Weiner and BWH neurologist Tanuja Chitnis, MD, are principal investigators of the SysteMS study, collaborating with experts at Google and Biogen to determine new biologic, physiological, environmental, and behavioral factors that influence a patient's experience with MS as the disease progresses. This study of 2,000 MS patients incorporates details related to physical and neurological examinations, magnetic resonance imaging (MRI), and molecular assays, along with data generated by wearable miniaturized sensors designed by Google to continuously measure patients' movement, activity, and vital signs.

Biologic profiling includes genetic information, immune activity, and other information derived from blood, urine, saliva, and stool samples. Multidimensional analysis of the datasets will be performed using a customized platform designed by the life sciences team at Google to identify factors associated with disease severity and progression. Researchers at Biogen will help to test new hypotheses and provide rapid feedback to quickly advance new findings.

"A great benefit from this study is being able to start an individual MS patient with the most effective therapy from the very beginning of the treatment for the disease, eliminating a lot of the trial and error that comes with the wide range of medications for MS," said Dr. Chitnis.

Feasibility Demonstrated in Study in Use of Smartphone Platform

A recent one-year smartphone study in MS, led by BWH neurologist Philip De Jager, MD, PhD, studied 38 participant pairs (MS and cohabitant) between 18 and 55 years-of-age. Illustrating several novel features of a smartphone platform, the study demonstrated the feasibility of utilizing a smartphone platform to gather useful passive and active performance data at high frequency in an unstructured manner in the field. The study was recently accepted for publication in Neurology and will appear in 2016.

"The daily capture of a participants' functioning in their own home environments offers us the ability to assess the participant's average performance the course of the year, as well as look at other study aspects, such as response accuracy and speed," said Dr. De Jager.

Tanuja Chitnis, MD
Medical Director, CLIMB Study,
Neurologist, Brigham Multiple Sclerosis Center
Brigham and Women's Hospital

Howard L. Weiner, MD
Director, Brigham Multiple Sclerosis Center
Co-director, Ann Romney Center for Neurologic Diseases
Brigham and Women's Hospital

Philip De Jager, MD, PhD
Neurologist, Brigham Multiple Sclerosis Center
Brigham and Women's Hospital