EAN congratulates you as the winner of the 2017 MS International Federation Charcot prize, recognising your lifetime of achievement in outstanding research into the understanding or treatment of MS.
David B. Vodušek (DBV): Can you tell us about your training and how you ended up looking after neurological patients with MS and pursuing research in MS?
Per Soelberg Sorensen (PSS): When I was a young doctor, I was fascinated by neurology because of the way the neurologist would deduct where the lesion in the nervous system was located based on the history and objective examination. This was before the appearance of scanners. My interest in MS was aroused by the complex immunology and, in particular, the appearance of immunological treatments of MS.
DBV: Can you tell the EAN pages readers the main contributions of your research in MS?
PSS: A main area in our research has been therapeutic trials in multiple sclerosis (MS). We were among the first to try serial plasma exchange as a treatment for MS. Later we pioneered treatment with intravenous immunoglobulin in relapsing-remitting MS, both as prophylactic therapy and as add on therapy to intravenous methylprednisolone for treatment of acute relapses. We have been at the forefront in combining traditional and new therapies of relapsing-remitting MS. Based on laboratory research we have initiated and conducted a number of combination trials of which 2 large international trials showed a beneficial effect of high dose methylprednisolone as add on therapy to interferon-beta 1a, and these findings have translated into daily clinical practice worldwide. We also performed combination trials with intravenous immunoglobulin and interferon-beta, simvastatin as add on to interferon-beta and minocycline as add on to interferon-beta but we were not able to show any beneficial effect of these combinations compared to interferon-beta therapy alone.
We have been instrumental in the application of tests for antibodies against biologic therapies, and this translational research has evolved into development of international guidelines and the use of measurement of neutralizing antibodies against interferon-beta has been adapted all over Europe.
Recently, I have been involved in epidemiological research using data from the Danish MS Treatment Registry and the Danish Multiple Sclerosis Registry including sex differences in MS, the effect of co-morbidities on the disease course in MS and the effect on children of having a parent with MS.
DBV: How do you see the present care for MS patients in Europe and in the world? Do you see any solutions to the inequalities of access to treatment?
PSS: Recent research has shown major differences in the present care for people with MS in Europe. New therapeutic guidelines, developed as collaboration between European Academy of Neurology (EAN) and the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), is an important step towards defining the appropriate therapeutic choices across Europe.
Another issue is the variation in access to and reimbursement of approved therapies for MS across the European countries. Hopefully, the common European guidelines for treatment of MS might be the first step towards a more uniform access to disease modifying therapy.
We are currently working on an initiative to define the MS care unit that should be established in all European countries to improve the management of people with MS. Differences in the management of MS patients are even more dissimilar when Europe, North America and Australia are compared to the rest of the world. In order to improve the worldwide status of management, European organisations like EAN and ECTRIMS will have to collaborate with sister organisations in other continents, and the task is exceedingly challenging.
DBV: What would you pick as the next milestone necessary to be achieved in MS research?
PSS: Whereas we have seen considerable improvements in the efficacy of disease modifying therapies for relapsing-remitting MS, we still need effective treatments for patients with progressive forms of MS. Recently, phase III trials of the anti-CD20 monoclonal antibody ocrelizumab and the sphingosine-1-receptor antagonist siponimod have shown promising results in primary progressive and secondary progressive MS, respectively. However, both treatments are anti-inflammatory and we need to develop neuroprotective and remyelinating therapies in order to establish effective therapies for patients with progressive forms of MS.
Research is needed to provide a better understanding of the mechanisms of disease progression translating into new therapies for progressive MS. Along this line we also need to establish imaging markers and biomarkers in body fluids for disease progression in order to develop faster clinical trials for new therapies in progressive MS.
DBV: How do you see the interaction of ECTRIMS and EAN, and what are your suggestions for future cooperation?
PSS: The first major joint project undertaken by ECTRIMS and EAN has been the development of common guidelines for disease modifying treatment in MS. I am confident that other guidelines will follow e.g. guidelines on symptomatic therapies and on treatment of relapses in MS. In addition, the establishment of joint symposiums during EAN and ECTRIMS congresses is an important collaboration, and a possible new avenue could be collaboration on teaching activities.
Also collaboration on European affairs in Brussels regarding the management of people with multiple sclerosis in Europe is an important mission for both organisations.
Prof. Soelberg Soerensen, I thank you for this very informative interview and wish you further success.
David B. Vodušek, Chair, EAN Communication Committee