Octopus trial offers new hope for people with MS in Southampton

A mega-trial for people living with progressive forms of multiple sclerosis (MS) has opened in Southampton.

The trial is being funded by the MS Society. They hail its opening as a ‘major moment for MS research’ that has potential to transform the clinical trials landscape.

Participants are now being recruited at University Hospital Southampton (UHS). It is one of 30 sites expected to open across the UK.

Living with progressive MS

More than 130,000 people live with MS in the UK. Tens of thousands who have the progressive forms have little to stop their MS getting worse.

Frank Bailey, 57, lives with his wife near Chichester and runs his own landscaping business. Eight years ago, he was diagnosed with progressive MS.

“It was a relief,” he recalls. “I can actually say I did cry when the neurologist told me. I didn’t cry because I had MS, but because I finally had an answer to what was wrong with me.

“I’d gone through ten years of people telling me it was my back. The last stop was a neurologist, and she told me I had MS. Having that meant I could deal with it.”

He says the condition has ‘massively’ affected his life. At work, he says he used to be able to lay 40 square metres of paving a day. Now he can only manage half that.

“I stumble and my balance is rubbish,” he explains. “It’s affected my eyesight - I never used to wear glasses, but now I do, just to see the fine detail.

“It’s frustrating. I have to find other ways of doing things, but I’m still doing the job I love doing.”

There are no treatments to prevent his type of MS from getting worse. One of the ways that Frank decided to take control was to join the Octopus trial.

While he says he’d be grateful if the treatment he receives stops his condition from getting worse, his main reason for joining was to help future generations.

“It’s been no problem taking part in a trial at all,” says Frank. “It’s a bit of a drive every time, but if we don’t put ourselves out for things like this then we just stand still.

“MS needs to be driven forward and put in the limelight more – especially my type, progressive MS.”

Innovative trial design

The Optimal Clinical Trials Platform for Multiple Sclerosis (OCTOPUS) is a multi-arm, multi-stage platform trial. The design means several drugs can be tested simultaneously, and can be added or stopped based on the results. It works up to three times faster than traditional trials.

The same approach has changed how men with prostate cancer around the world are treated. This has helped answer eight research questions about treatments in 15 years rather than 50 years.

Professor Ian Galea, Principal Investigator of the trial at UHS, said:

“Southampton has a long-standing expertise in progressive MS studies. Since progression in MS is likely to have many influencing factors, we take a number of different approaches.

“Recently we completed a study which examined the link between infections and spinal cord shrinkage. We are the third highest recruiting centre in the MS-STAT2 trial, testing a cholesterol-lowering drug in secondary progressive MS.

“Scientific studies are also examining the role of two potential drivers of progression: haemoglobin, the red pigment in blood, and the blood-brain barrier, which serves to protect the brain during infections.

“Octopus will therefore be another important study in a local portfolio of MS research that is laser-focused on stopping progression in MS.”

Neurologist Professor Jeremy Chataway at University College London, who is leading the study, says:

“The multi-arm, multi-stage approach to trialling emerging medications has been utterly transformative in other conditions, so I’m thrilled we’re now able to apply it to progressive MS. Ultimately, Octopus will lead to more treatments for progression becoming available to people living with MS sooner.

“Getting to this stage has been an incredible joint effort of people up and down the country. The other large trial I am the Chief Investigator for, MS-STAT2, has shown we can run large-scale, nationwide trials for progressive MS.

“Now we're taking it to the next level, as we start a new journey to develop treatments for progressive MS. I know our amazing community of people is poised to help us make it to the top, so we can find the answers we so desperately need.”

Selecting potential treatments

The first two drugs being tested are metformin and a version of alpha-lipoic acid. Metformin is a drug commonly used to treat a type of diabetes, which may help to regenerate the myelin sheath around nerves. Alpha-lipoic acid is a food supplement that acts as an antioxidant.

These form the first two ‘arms’ of the Octopus trail. More will be added in the future.

They were chosen by a team of experts and people with MS. The group have spent years reviewing treatments, including those already used for other conditions, to find those most likely to help slow down disability progression in people with MS.

Dr Emma Gray, Assistant Director of Research at the MS Society, says: “This is a major moment for MS research – Octopus has the potential to change the clinical trials landscape around the world. It's thanks to all the wonderful participants that trials like Octopus can happen.”

Professor Galea, Professor of Clinical and Experimental Neurology at the University of Southampton, said: “Octopus is a landmark trial, since it is designed to maximize the probability of finding a treatment for progressive forms of MS in the shortest possible time. It is high time that people with progressive MS receive the attention they deserve, and the MS Society has invested heavily to advance research in this area.

“In Southampton, we have been selected as a regional hub for this trial to recruit around 125 people with progressive MS. With this comes responsibility to follow up all trial participants, to see whether the treatments are slowing progression. As a research team, we will do our best to support participants’ retention on the trial so they can see the results of their efforts.”

If you would have progressive MS and would like to take part in the Octopus trial in Southampton, you can find out more and register your interest on the MS Society website.