A breakthrough in the way MS is managed may be on the horizon thanks to a new clinical trial which starts this month at Nottingham University Hospitals NHS Trust.
The AIMS trial (Artificial Intelligence to predict worsening of Multiple Sclerosis despite treatment) draws on Nottingham’s world beating heritage in MRI (Magnetic Resonance Imaging). It will use the scientific know-how of Nottingham-based experts in MS, computer science and artificial intelligence and imaging.
Researchers will analyse hundreds of MRI scans and clinical data already collected from people with Multiple Sclerosis (MS) with their consent, and apply artificial intelligence (AI) techniques to these to identify ways of predicting the outcomes of MS.
Dr Radu Tanasescu, Consultant Neurologist at Nottingham University Hospitals, who is leading the AIMS trial said:
“At least a third of people with MS who are on an initial MS treatment later need to be switched onto a stronger therapy.
“But, by identifying early, at diagnosis, patients who are likely to fare worse over the long term, we could offer these patients a more tailored treatment approach. This is a crucial step towards ‘personalised medicine’, which means we'll be able to prescribe the right medication for the right person at the right time.”
The study team’s IT specialists will train a computer to use mathematical models to predict whether a person's MS will mean they will suffer greater disability or cognitive impairment over the long-term.
According to Dr Tanasescu, who sees patients with MS every week in his Neurology clinic at Queen’s Medical Centre, Nottingham, the city is the ideal place to host this study, as the research demands a wide range of expertise.
The AIMS study will take advantage of strong collaboration between clinical partners in the NHS and internationally, and academics at the University of Nottingham. The study will link directly with the DELIVER-MS trial, another research project which seeks to answer the important question: does early treatment with highly effective treatment improve the prognosis for people with MS?
It will draw on a network which includes the Nottingham MS Clinic at the QMC, existing research programmes and their international collaborations, the NIHR Nottingham Biomedical Research Centre and the University of Nottingham.
Dr Tanasescu added: “Access to the treatments in MS has been improved recently. But although most people with relapsing MS can benefit from them and outcomes are improving as a result, no single treatment is right for everybody.
“Some people living with MS will relapse, and over the long term will gather psychical and cognitive disability. Despite progress in assessing patients’ response to treatments, individual prediction of MS outcomes over the long-term is still inaccurate. The need for information on individualised long-term prognosis for MS patients' forecasting is frequently unmet.”
MRI scanning, which was invented in Nottingham by the late Nobel Prize winner Sir Peter Mansfield, plays a vital part of the AIMS trial.
Powerful magnets within the MRI scanners are a vital tool in diagnosing and monitoring MS in patients. A wealth of clinical and MRI data from patients with MS are acquired every year in clinical practice, but only part of this data is traditionally used for clinical decision-making.
Under the AIMS trial, researchers propose that a set of structural characteristics from MRI brain scans from people with MRI are taken which relate to biological changes which are meaningful to MS. These characteristics may therefore act as predictive markers for how MS will progress in patients.
Dr Tanasescu said: “We intend to harness more valuable information from routine MRI scans and existing NHS clinical data with our study, which makes the research cost-efficient. I am aware of the complexity and challenge in applying AI in a clinical setting. But through collaboration, support from AI experts and a robust plan, we aim to make a breakthrough.”
He added: “We hope this study will have a direct benefit for patients. And we aim to expand our knowledge of Multiple Sclerosis using real-world clinical data.”
Dr Tanasescu is one of just three consultants at Nottingham University Hospitals to have been awarded a special grant from the Medical Research Council (MRC) for his research project. The Clinical Academic Research Partnerships (CARP) is a new initiative which aims to support more NHS clinicians to take part in clinical research.