Jeremy Chataway, MA, PhD, FRCP, UCL Institute of Neurology, London, UK, gives an insight into the Octopus trial, the first-ever multi-arm, multi-stage (MAMS) trial for progressive multiple sclerosis (MS). He highlights the treatment of progression of disability, in both primary and secondary MS, as a major unmet need. While there are some emerging early treatments that are now available to control the inflammatory aspect of progression, such as ocrelizumab and siponimod, these are likely to have a small effect. Thus, Prof. Chataway explains that he is focused on influencing the neurodegenerative component of progressive MS, where the goal is to slow down or halt disability accumulation. The Octopus trial follows a MAMS design, which speeds up the process of testing treatments for progressive MS. In contrast to conventional randomized controlled trials, Octopus allows for multiple medications to be tested in parallel and compares them to a single control group, to determine whether they are effective in slowing the progression of MS in a faster way. In this way, the trial has the flexibility to drop drugs that do not look promising and introduce new agents as they emerge. Prof. Chataway also clarifies how the trial has had different work streams over recent years, looking at the statistical mechanics of the trial design and the drug choices, with a particular interest in repurposed drugs. This interview took place during the 2022 Multiple Sclerosis at the Limits Conference in London, UK.
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