Neurology Central

Gavin Giovannoni on why time matters in multiple sclerosis

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Gavin Giovannoni is the Chair of Neurology at Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry (UK). We discussed his career to date, promising therapeutics for multiple sclerosis and his involvement with the MS Brain Health Initiative, a campaign calling for changes in strategies for multiple sclerosis management.

Article in Neurodegenerative Disease Management now available

What inspired you to work in the field of inflammatory disorders, with a particular interest in multiple sclerosis (MS)?

On entering medical school I wanted to specialize in psychiatry, but soon realized it wasn’t the field for me. However my first encounter with a real patient in 1985, a lady in her mid-40s with multiple sclerosis (MS), was a transformative experience. At this time there were no treatments for MS and the uncertainty of life with the disease really struck me. Approximately 18 months later I had decided to become a neurologist and have since dedicated my career to studying MS and developing effective treatments for people with MS.

What would you describe as the biggest achievement of your career to date?

I think that my biggest achievement has been my involvement, as part of the larger community, in clinical trials. Because, ultimately, delivering highly effective therapies to market is what has transformed MS care.

How has multiple sclerosis care changed over the course of your career?

Massively. Prior to the first disease-modifying treatments all we could offer was diagnosis. We could manage relapses using steroids, but would ultimately watch people deteriorate over time. Individuals were always on the ward with terrible relapses, undergoing rehabilitation and physiotherapy.

Now we’re beginning to see a massive change in the natural history of the disease; it’s unusual now to see disabling attacks if you start individuals on therapy early enough. We’re not passive anymore, we’re not just watching the disease, we have hope and we can offer our patients hope. Plus, after the latest ECTRIMS meeting (7-10 October 2015, Barcelona, Spain) and the positive trial results of ocrelizumab, we can now offer some hope to people with primary progressive MS.

Yes, you were involved with the release of initial data from the Phase III trial of ocrelizumab, can you tell us a bit more about this trial?

There were three trials, two in relapsing MS and one in primary progressive MS. We expected the relapsing trials to be positive based on the Phase II data. But when the results were confirmed it was probably even better than we’d hoped because, while the efficacy was still very high, the safety profile of the drug was also very favorable.

The third benefit of this particular compound is that the monitoring requirements have dropped compared to the other therapies in this category. This makes it a real game changer in the sense that we have a high efficacy drug that looks relatively safe with very little monitoring, making it feasible for widespread use.

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Disclosure

GG is a steering committee member for AbbVie’s Daclizumab trials, Biogen-Idec’s BG12 and Daclizumab trials, Novartis’ Fingolimod and Siponimoid trials, Teva’s laquinimod trials and Roche’s Ocrelizumab trials. He has received consultancy fees for Biogen-Idec, Merck-Sorano, Novartis and Genzyme-Sanofi advisory board meetings, GSK’s phase 3 MS trial programme and Synthon BV DSMB activities. He has received honoraria for speaking at Genzyme-Sanofi and Biogen-Idec meetings.

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