Mining data to better understand multiple sclerosis
30 January 2013
Dr. Helen Tremlett (2004 Trainee; 2007 Scholar) and Dr. Elaine Kingwell (2002 Trainee – PhD; 2011 Trainee – Post-Doctoral Fellow) are two members of the UBC PiMS* Research Group who are using a set of data unique to our province to attempt to quantify many commonly held perceptions about multiple sclerosis (MS) and its impact on people with the disease.
“Multiple sclerosis is a difficult disease to measure. Its symptoms can vary widely from individual to individual so it is challenging for both patients and clinicians to know if a person is responding to a particular treatment or not,” said Tremlett, an associate professor in the UBC Faculty of Medicine and a member of the Brain Research Centre at UBC and Vancouver Coastal Health Research Institute.
Both Tremlett and Kingwell were the lead authors on recently-published studies that have generated significant attention in the MS community and beyond. These observational studies were made possible by the BC Multiple Sclerosis Database, which contains detailed information, documented by BC MS neurologists, on nearly 8,000 British Columbians with MS. It is the only database of its kind in the world, and BC is one of the only jurisdictions where researchers can link data from this database to other sources of population health information such as Population Data BC (an MSFHR-funded platform), the BC Cancer Registry, and the BC Perinatal Database Registry. This gives researchers the opportunity to examine the relationships between MS and many other conditions and also compare the MS population with the broader population.
Tremlett, who is also a Canada Research Chair in Neuroepidemiology and Multiple Sclerosis, was lead author on a study published last October in the Multiple Sclerosis Journal that quantified improvements in disability in MS patients. Her study showed that up to 15 percent of MS patients who aren’t taking any specific “MS disease modifying drugs” showed improvements over a one-to two-year period. Those most likely to improve were younger, female and had the relapse-remitting form of the disease.
|The UBC Pharmacoepidemiology in Multiple Sclerosis Research Group. Dr. Helen Tremlett is seated second from left; Dr. Elaine Kingwell is standing third from left.|
In another study published in the Journal of the American Medical Association (July 2012), Tremlett’s team, with lead author Dr. Afsaneh Shirani, concluded there was no strong association between beta interferon exposure and disability progression in patients with relapsing-remitting MS in the real-world clinical practice setting in BC. Beta interferons are a commonly-prescribed medication thought to slow down disability progression in patients with MS.
Tremlett is quick to point out that beta interferons may benefit some MS patients with respect to long-term disability progression. The key is to discover which subgroup benefits the most and target the medication appropriately. That, she hopes, will be the subject of a future study.
Kingwell used the data available in BC to conduct the first North American study of the connection between MS and cancer. Her research showed that people with MS have a lower incidence of cancer than the general population, but that MS patients typically had larger tumours at diagnosis, suggesting that some tumours may be caught later in people with MS.
Kingwell emphasizes that this study is important for MS patients and their physicians.
“It highlights that they should be aware that not all their symptoms may be due to MS. They can have co-morbidities, like cancer, and patients and physicians are encouraged to follow recommended cancer screening guidelines.”
“The data that we used for this study was particularly valuable because it included a cohort of patients who haven’t been treated with beta-interferons. It provides a reference point for examining the relationship between beta-interferons and cancer risk.”
Tremlett hopes these studies stimulate further research into the disease.
“There are still so many unanswered questions. What our research does is give clinicians and researchers a reference point for other studies investigating potential impacts of various interventions.”
*Pharmacoepidemiology in Multiple Sclerosis Research Group (http://epims.med.ubc.ca/)