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Uh good. Good morning, everyone. We're going to make that next start. You are very welcome to the morning session of this M s masterclass for 2022. The reason we're all here today is because of the complexity of multiple services, the costs of multiple services and the impact it has on the patients that are affected by that. Those impacts are direct and indirect. They are pharmacological, non pharmacological. The costs are born by health and social care budgets. They're born very heavily by the patients themselves and obviously born two by families. A lot of those costs are unrecognized and unpaid has an impact on patient's life, opportunities and life choices. One of the biggest and most relevant impacts is that unemployment, unemployment opportunities that patients have the kritzky scale is a scale which measures disability somewhat crudely, on a scale between zero and 10, with the high levels of disability being at the upper echelons of the scale even at very low levels of that scale. However, where patients are still fully ambulance with an EDSS score of 3.0, the impact on employment is really quite substantial. You might notice on this particular graph. UK is in black that we don't actually show up too well in comparison with certain other countries. And you might observe that thing's always seem to be a bit better in Sweden. With regard to these issues, in terms of the health impact pliability impact on health, it really impacts on the perceptions that patients have about their condition. That's quite striking information and the killing. The patient's age 18 to 29 years of age have a poor perception of their health status compared with the general population over the age of 80 25 years ago were. So when I was starting out as a registrar, there were no approved disease modifying therapies for M s, at least in the UK The FDA had approved but interferon in 1993 in the A m A 1995. But but nice didn't approve the interferons, and indeed it never did. And I'm probably one of the only people still in the room who can remember recruiting patients to the risk sharing scheme, which was seen as a way of circumventing that refusal. Bye. Nice. In 2022 the situation is somewhat transformed, particularly for patients with relapsing remitting disease. There's a range of first line options and inverted commas. Familiar injectable therapies that have been on interferon Copaxone. An increasing number of oral disease modifying therapies, including one approved this year by Nice to 2022 ponies mode. A range of infusion therapies, which would be the most highly effective treatments that we have available on your metabolism. Ocrelizumab and off for tomorrow. And then for certain selected patients who fail on those sorts of treatments, there is a potential option of stem cell transplantation. These drugs do have an impact. They do have an impact, a benefit for patients particularly treated over the longer term, There's some data looking at patients enrolled in the original trials have been interfering. That indicates that patients randomized to the treatment group had a better life expectancy than those randomized initially to the placebo group over a period of 21 years. In terms of the highly effective therapies, the impact on MRI in terms of accumulating lesion load new lesions is really quite substantial. So these are positives, but they're not complete solutions for patients with M s. And of course, not all of our patients have relapsing remitting disease. Until very recently, we really had no treatment options at all for those with progressive a mass. But just within the last few years, we now have the option of ocrelizumab therapy for patients with your ambulance with primary progressive disease within 15 years of onset. And more recently, Sopon Ahmad has been approved for use in patients with active secondary, progressive disease or however many questions and unresolved issues. How effective are the currently approved therapies that we have listed in the real world, where patients have to contend with a variety of comorbidities and other challenges? Can we reasonably compare the efficacy of different disease modifying therapies where the trial data doesn't exist, where it's weak or perhaps even conflicted? What impact the co morbidities have? An outcomes and prognosis the comorbidities affect the efficacy of some of the interventions are they're marginal gains that we can achieve outside of pharmacological interventions. How do we deal with certain challenging patient groups? Children, adolescents? What can we say to them about prognosis? What can we say to them about safety of interventions? What about women of childbearing age? Are the drugs safe in pregnancy what impact the pregnancy have and one of the patients over the age of 60 which is really the biggest growth group amongst RMS population, Do the drugs work as effectively in this group of patients? How good are we at pharmacovigilance some of the drugs that we listed earlier on Do you have serious potential side effects as well as impressive benefits are the important safety signals that can be identified, or even a swayed by the comprehensive collection of real world data and some more? Can we pick out those patients early on in the clinical course who really need effective intervention? And what level of intervention are there? Even certain patients who are unlikely ever to require any of the treatments that we have to offer? How does the organization of health care in different countries influence outcomes showing a slight early on employability, unemployment, long term that where you live can impact on whether you stay in employment? If you have a mask, how do we plan services for patients with Ms more effectively? What can we offer to those patients with progressive disease, particularly those who are no longer able to walk in terms of effective therapy. Are there simple interventions that might be added, perhaps repurpose drugs to existing disease, modifying therapies that can improve outcomes to why did most clinical trials focus largely on the ability to walk? Well, the obvious answer to that is being able to walk is really important. But of course, you can see that in terms of employment, e s s three normal ambulation significant drop off on that, that there must be other factors. What about cognition? Isn't upper limb function important too? And how does the lab advance our understanding of this disease and informed the treatment strategies that we have? How do we bring the bench to the bedside? Well, happily, with all of these questions this morning and and many more the organizing committee have brought together a very impressive list of speakers and chair to move us through these issues, present answers to them and perhaps um, indicate how we might find answers in the year ahead and the years ahead. So still is going to be charged. Stella Hughes, my colleague in Belfast. With them, a talent are has done so much of the last two or three years in particular to bring together the UK Trials and Registries Consortium We called a grade would be familiar. Too many in the audience. Who? The board member with M s base with local researchers on the island of Ireland, including, including Rachel Key here from Queens. And she need Heinz from Galway. We have a great pleasure of having a professor Melinda McGary, who's the director of the really impressive Danish multiple sources registry, about which we could learn so much here in Ireland and maybe someday seek to replicate. And we have our keynote speaker this afternoon, Professor. Clash, Smear. I think we're in for for a treat today. It will be a very enjoyable morning. I'm sure Just a reminder about a couple of things. Don't forget about the posters that are upstairs. They reflect a lot of hard work by dedicated researchers across the island and elsewhere. Uh, your evaluations to fill those out whenever you receive the invitation by email. One other notice that that have been asked to make is that due to the time that we're living in in the period of mourning, that, uh, posting about the meeting on social media is currently discouraged. So I think that's all I want to say and I'll hand over to the chair will introduce our first speaker this morning.