PCORI and the National Multiple Sclerosis Society Take On Vital Research Questions
- 2023 Annual Meeting
- The PCORI Strategic Plan
- Clinical Effectiveness and Decision Science
- Dissemination and Implementation
- Evaluation and Analysis
- Healthcare Delivery and Disparities Research
- PCOR Infrastructure & Innovation
- Our Vision & Mission
- Financial Statements and Reports
- The PCORI Strategic Plan
- Board of Governors
- Methodology Committee
- Authorizing Law
- Evaluating Our Work
- PCORI's Advisory Panels
- Procurement Opportunities
Past Opportunities to Provide Input
- Stakeholder Views on Components of 'Patient-Centered Value' in Health and Health Care (2023)
- PCORI's Proposed Research Agenda (2021-2022)
- Proposed National Priorities for Health (2021)
- Proposed Principles for the Consideration of the Full Range of Outcomes Data in PCORI-Funded Research (2020)
- Proposed New PCORI Methodology Standards (2018)
- Data Access and Data Sharing Policy: Public Comment (2017)
- Proposed New PCORI Methodology Standards (2017)
Comment on the Proposed New and Revised PCORI Methodology Standards (2016)
- 1. Standards for Formulating Research Questions
- 10: Standards for Studies of Diagnostic Tests
- 12. Standards on Research Designs Using Clusters
- 13: General Comments on the Proposed Revisions to the PCORI Methodology Standards
- 2: Standards Associated with Patient-Centeredness
- 3: Standards for Data Integrity and Rigorous Analysis
- 4: Standards for Preventing and Handling Missing Data
- 5: Standards for Heterogeneity of Treatment Effects
- 6: Standards for Data Registries
- 7: Standards for Data Networks as Research-Facilitating Structures
- 8. Standards for Causal Inference Methods
- 9. Standards for Adaptive Trial Designs
- Peer-Review Process Comments (2014)
- Draft Methodology Report Public Comment Period (2012)
- Past Opportunities to Provide Input
Receiving a diagnosis of multiple sclerosis can be frightening. I know firsthand—I was diagnosed in 2013 shortly after I turned 29, and after experiencing symptoms such as numbness, tingling and vertigo. I learned I had lesions on my brain and spinal cord. When I found out I had MS, I felt lost, overwhelmed, and helpless. I worried about my future and mourned for my past.
The disease, which affects around 2.5 million people worldwide, comes in several forms with many manifestations. Symptoms can include vision problems, fatigue, pain, and loss of coordination. Much like our varied symptoms, patients embark on different journeys. But while our individual experiences may be unique, there are similar underlying needs and conversations that must be had.
Both the National Multiple Sclerosis Society and the Patient-Centered Outcomes Research Institute work closely with patients and caregivers to fund research on MS. In recognition of MS Awareness Week, March 11–17, I want to highlight five of PCORI’s funded research studies that aim to help make care more individualized to patients’ needs.
Would You Rather
Recently, I began an aggressive disease-modifying therapy (DMT) after new active lesions popped up on an MRI. With daunting side effects ahead, escalating my treatment was scary and the process taxing. But I know that all treatments mix risks and benefits. We ask ourselves, “What can I endure now to give myself a better quality of life later?” It’s a real-life game of “Would You Rather.”
With so much at stake, it’s important to understand whether using stronger treatments early after diagnosis will prevent or delay the worsening of symptoms, or whether we should wait to use aggressive treatment until after our MS has progressed. Two PCORI funded studies, one at the Cleveland Clinic Foundation and the other at Johns Hopkins University, are comparing these treatment strategies.
Results from these studies may mean that patients in the future won’t be in my situation, wondering what would have happened if I had started aggressive therapy sooner.
We ask ourselves, 'What can I endure now to give myself a better quality of life later?’ It’s a real-life game of ‘Would You Rather.'
To Treat or Not to (Continue to) Treat
Most people with MS begin taking DMTs in the early stages of the disease, as research shows that’s when the treatments are most effective. But research has also shown that relapses and the appearance of new lesions decrease as we get older, and that DMTs are less effective at treating MS in its later phases.
So, could it be safe to stop taking DMTs later in life?
A project at the University of Colorado Denver asks whether patients age 55 and older who haven’t had a relapse or change in a brain scan for five years can stop taking DMTs without their MS worsening. It’s learning whether patients who continue DMTs have a difference in quality of life and in symptom progression compared with those who stop.
I’ve chosen to discontinue DMTs for periods of time in the past, and while it was freeing to get a break from pills or injections, I couldn’t shake the fear that I had opened a door to more damage or disability.
But opposing questions arise, too: Is it worth the cost, risk, and toll on our bodies to continue DMTs as our MS progresses?
I’m not thrilled about the idea of taking a DMT forever, but I’m also not sure how I would respond if my doctor advised me to stop. Would I feel like I was giving up? Would I feel relieved? What if the disease started to progress again after a quiet period? Research into the safety and effectiveness of this option could help me decide.
Miles to Go Before We Sleep
Fatigue is my worst, most consistent symptom. It’s also the most common symptom across patients with MS. I have to decline invitations and miss out on social activities. I sometimes rely heavily on my husband to do the bulk of household chores. I struggle to help others understand what MS fatigue feels like.
There are no approved medicines to treat MS-related fatigue, but doctors often use amantadine, modafinil, and methylphenidate, which have been approved to treat other health problems. This Johns Hopkins University study is comparing each of these medicines to see which works best to treat MS-related fatigue.
Managing fatigue is a tricky endeavor, so having an evidence-based way to help us decide how to do so will be very helpful.
Somebody to Lean On
Many people with MS struggle with depression. It’s an often-overlooked symptom, and it’s also a common side effect of DMTs. Financial struggles, feeling like a burden to family and caregivers, and uncertainty over future health and quality of life can make this struggle harder.
Evidence-backed physical and behavioral treatments for depression exist, but many MS patients either don’t know about them or don’t have access to them. A study at the University of Washington asks if a collaborative care approach can help control depression and chronic pain and improve overall quality of life. In the approach being tested, a nurse, supervised by physicians, psychiatrists, and psychologists, coordinates and provides treatment for depression as guided by patients’ goals and preferences.
I’ve struggled with MS-related depression, and while I’ve never experienced collaborative care, I can imagine its benefits. There’s a stigma attached to depression that we need to work through. We shouldn’t feel shame for struggling.
But MS doesn’t have to be all negative. Life doesn’t end here.
Each of these studies raises questions that are often neglected or uncomfortable to consider. No matter what patients’ views are on these topics, my hope is they plant seeds for more assertive self-advocacy. I encourage patients to speak to their specialists and share their thoughts and concerns.
The views expressed here are those of the author and not necessarily those of PCORI.
March 22, 2020, 8:37 PM
Comment by MeganNah,
September 2, 2019, 8:45 AM
Comment by Sullivan,
MS affects the areas of the brain and spinal cord known as the white matter, destroying a fatty layer called the myelin sheath, which wraps around nerve fibers and electrically insulates them. When myelin is lost, the axons of neurons can no longer effectively conduct action potentials.
April 13, 2018, 9:21 PM
Comment by PCORI,
Thank you for your comment, Mr. Slattery. Prior research has shown that for relapsing-remitting MS, the risk of relapses and new lesions decreases as people age and disease-modifying therapies are less effective. For instance, this study found the relapse rate decreasing by 17 percent every five years. Other studies have reported similar findings. We cannot, of course, provide medical advice about your specific situation.
April 2, 2018, 5:57 AM
Comment by Kevin S.,
Hi Cat, I have CIS form MS. I am wondering where the information regarding MS lesions or progress diminishing with later age is from?
What's Happening at PCORI?
The Patient-Centered Outcomes Research Institute sends weekly emails about opportunities to apply for funding, newly funded research studies and engagement projects, results of our funded research, webinars, and other new information posted on our site.
Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your point. You obviously know what youre talking about, why throw away your intelligence on just posting videos to your weblog when you could be giving us something enlightening to read?