Carrie Hersh, DO, MSc

“To this day, we really don’t have a clear understanding of exactly how we need to be measuring [cognitive impairment and decline] in the most ideal way.”

Although the treatment landscape for relapsing forms of multiple sclerosis (MS) is full of promise and availability therapies, the case is slightly less so for progressive forms of the disease. Additionally, due to the impact of progressive forms of MS spanning to include cognitive impairment, the process of measuring its progression becomes more difficult.

For Carrie Hersh, DO, MSc, assistant professor of neurology, Lerner College of Medicine, and neurologist, Luo Ruvo Center for Brain Health, Cleveland Clinic, the use of the Expanded Disability Status Scale (EDSS) score, while important, does not cover all the bases. Currently, specialists in the MS space such as Hersh are focused on addressing this challenge.

To find out more about how that process is underway at Cleveland Clinic centers, 

 sat with Hersh at Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum, February 27-29, 2020, in West Palm Beach, Florida. She discussed some of the efforts of the clinic’s MS Performance Test.

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The assistant professor of neurology at the Lerner College of Medicine and neurologist at Luo Ruvo Center for Brain Health, both of Cleveland Clinic, discussed the challenges of current measurements and the need to adjust the reading of progressive MS.

Carrie Hersh, DO, MSc: Measuring Progressive Multiple Sclerosis

“While we have demonstrated that early highly effective therapies in MS are key to forestalling early inflammatory disease activity that later prevents progression and disability accumulation later on, there is still quite a knowledge gap in terms of how we treat non-lesional activity.”

Many specialists in multiple sclerosis (MS), including Carrie Hersh, DO, MSc, assistant professor of neurology, Lerner College of Medicine, and neurologist, Luo Ruvo Center for Brain Health, Cleveland Clinic, have expressed their excitement about the modern landscape of MS treatment. With multiple options available and a solid base of understanding for treatment plans, physicians have never been better positioned to treat their patients.

Although, there remain challenges in care, with a major hurdle being the treatment of progressive disease, where inflammation is no longer the underlying driver of the disease. At 

America’s Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum

, February 27-29, 2020, in West Palm Beach, Florida, a number of suggestions were presented for antigenic targets for the treatment of these patients.

sat down with Hersh to find out what the meeting had to offer and what is currently being discussed as a potential method of preventing or slowing that progression in later disease.

The assistant professor of neurology at the Lerner College of Medicine and neurologist at Luo Ruvo Center for Brain Health, both of Cleveland Clinic, spoke to the importance of preventing progression in MS and treating the non-inflammatory aspects of the disease.

Carrie Hersh, DO, MSc: Addressing Progressive Disease in MS

“We’re no longer going to be able to rely on just RCTs because we’re no longer going to have those [drug-to-drug] comparisons. Being able to leverage what we’re seeing in real-world practice using all sort of different datasets from different institutions is going to play an increasingly important role.”

While the armamentarium for treating multiple sclerosis (MS) has grown quickly in the past decade—now counting more than 15 disease-modifying therapies&mdash;the days of being able to rely solely on data from randomized clinical trials (RCTs) for comparative efficacy data are long gone.

Although real-world datasets can be messy compared to more uniform RCT patient populations which are highly controlled, now, using ever-adjusted and complex propensity score models has allowed for physicians to compare “apples to apples, instead of apples to oranges,” as Carrie Hersh, DO, MSc, put it. 

Hersh, an MS neurologist at Cleveland Clinic’s Lou Ruvo Center for Brain Health, spoke with 

2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC)

, May 28-June 1, in Seattle, Washington, about how the increasing popularity of real-world datasets has brought a need for physicians to adequately compare patient populations to avoid indication bias. Hersh shared her insight into what propensity scores can offer the MS physician community.

The MS neurologist at Cleveland Clinic’s Lou Ruvo Center for Brain Health discussed how leveraging real-world datasets can help reduce indication bias when comparing treatments for multiple sclerosis.

Carrie Hersh, DO, MSc: Assessing Real-World MS Data to Compare DMTs

“It’s becoming increasingly more important to use shared decision making, or personalized treatment choices, because there are just so many different therapies that are available.”

When it comes to decision making regarding therapeutics for patients with multiple sclerosis (MS), the trend among neurologists has been to utilize a more personalized approach which incorporates the patient into the process. Referred to as shared decision-making, this allows for physicians to take into account a number of influencing factors—aside from the effectiveness of the therapy&mdash;that may impact which of the growing number of disease-modifying therapies would be best for a given patient.

Carrie Hersh, DO, MSc, an MS neurologist at Cleveland Clinic’s Lou Ruvo Center for Brain Health, spoke with 

, May 28-June 1, in Seattle, Washington, about this process. Additionally, she shared her insight into the specific facets that should be taken into account when making these decisions, such as tolerability, affordability, and patient-related factors, such as the desire to start family planning.

Hersh also discussed how to best go about comparing and contrasting disease-modifying therapies, and which measurements and outcomes will be the best to utilize in clinical trials going forward and when collecting real-world data on the effectiveness of these therapies.

The MS neurologist at Cleveland Clinic’s Lou Ruvo Center for Brain Health spoke about the factors that should be taken into account when making treatment decisions in MS, such as tolerability, affordability, and the desire to start family planning.

Carrie Hersh, DO, MSc

Articles

Carrie Hersh, DO, MSc: Measuring Progressive Multiple Sclerosis

Carrie Hersh, DO, MSc: Addressing Progressive Disease in MS

Carrie Hersh, DO, MSc: Assessing Real-World MS Data to Compare DMTs

Carrie Hersh, DO, MSc: Shared Decision Making in Multiple Sclerosis