|Timothy Vollmer, MD|
Medscape Interview: DR. VOLLMER BELIEVES THAT THE GOAL OF TREATING MS
On the eve of a major MS meeting, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, taking place next week in Copenhagen, Denmark, Medscape Medical News asked several MS experts to give their views on this question, as well as how they use the various different agents that are currently available.
Another expert who believes in the "hit it hard early" strategy is Timothy Vollmer, MD, University of Colorado School of Medicine, Denver. "The therapeutic goals are changing," he told Medscape Medical News. "We are moving from slowing the disease down to inducing full remission."
Dr. Vollmer points out that most disease activity is subclinical. "Physicians can't tell by looking a patient what is happening in their brain. Even an MRI once a year is inadequate. You need high-resolution 3D volumetric scans to see brain atrophy. This is not routinely done. If we allow the management to be governed by symptoms we are trading off function in later life. The goal should be to preserve function now so as to reduce lifelong disability. Disability has been correlated with reduced brain volume on MRI, so we can rank the drugs on their effect on inflammation and brain atrophy.
"The trouble with keeping the powerful drugs for advanced disease is that you need some brain reserve left to show improvement. That is why I think we need to treat early to maximize benefit with these drugs," Dr. Vollmer said. "In appropriately selected patients they can be just as safe as interferons, but much more effective."
"We are more aggressive at our center, but we are using the data as it has been published to make decisions," he adds. "I think this is the way it will go in the future. Other experts worldwide think similarly. However, the vast majority of general neurologists are not at this level. We are in the relatively unusual position of having been involved in all the studies. I've seen all the data at investigator meetings — more than that which has been published — so I have more confidence than most."