What is your brain worth to you?

Gavin Giovannoni

Barts and The London

Control Multiple sclerosis

RIP

730 HP

? 30 BP

Brain Power (BP)

Brain atrophy occurs across all stages of the disease

De Stefano, et al. Neurology 2010

n= 963 MSers

www.multiple-sclerosis-research.org

www.multiple-sclerosis-research.org

www.multiple-sclerosis-research.org

Defining the window of opportunity to treat MS?

21-year long-term follow-up of IFNb-1b study time from study randomization to death

Early treatment (3 years) with IFNb-1b was associated with a 47% reduction in the risk of dying over 21 years compared with initial placebo treatment

Goodin et al Neurology. 2012 Apr 24;78(17):1315-22.

At risk:

IFNB-1b 250 µg

Placebo

124

123

124

120

121

117

118

109

104

88

HR=0.532 (95% CI: 0.314–0.902)

46.8% reduction in hazard ratio

Log rank, P=0.0173

IFNB-1b 250 µg

Placebo

65%

70%

75%

80%

85%

90%

95%

100%

0 2 4 6 8 10 12 14 16 18 20 22

Pro

po

rtio

n o

f p

ati

en

ts w

ho

are

sti

ll a

live

Time (Years)

Theoretical model: treat early and effectively

Natural course of disease

Later intervention

Later treatment

Treatment at diagnosis Intervention

at diagnosis

Time Disease Onset

Dis

abili

ty

Defining your treatment strategy?

survival analysis

“hit hard and early ”

MS is an autoimmune disease hypothesis

15-20 year experiment

What is your treatment philosophy? maintenance-escalation vs. induction

Can you name me any diseases that you don’t treat early?

Time is Brain

Conclusion

Definition of dementia

Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness.

• Normal activities of daily living

• Physical

• Mental

• Social

• Occupational

• Lasting more than six months

• Not present since birth

• Not associated with a loss or alteration of consciousness

“Multiple sclerosis is therefore a preventable dementia.”

www.multiple-sclerosis-research.org