ACTRIMS 2022 | Biology or poor trial design…What underlies remyelination trial failures in MS?

Developing successful neurorestorative therapies is a principal goal in multiple sclerosis (MS) research and one which has proved to be a major challenge. The failure of several putative agents in recent trials has raised the question of whether the lack of success is biological or due to poor trial design. Gavin Giovannoni, MBBCh, PhD, FCP, FRCP, FRCPath, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK, shares his thoughts on the downfalls of clinical trials investigating neurorestorative therapies. While remyelination therapies may be successful in promoting myelin production, neurorehabilitation and exercise are crucial to stimulate the biological mechanisms of recovery. Prof. Giovannoni emphasizes the need to integrate neurorehabilitation and exercise into clinical trial protocols testing remyelination strategies. Additionally, understanding the time frame when repair occurs and selecting patients with the capacity for repair is critical. Prof. Giovannoni notes that the addition of rejuvenation therapies to remyelination strategies may be beneficial to overcome the effects of aging on recovery. This interview took place at the ACTRIMS Forum 2022 in West Palm Beach, Florida.