Understanding Silent Progression in Multiple Sclerosis: Bruce Cree, MD, PhD, MAS, FAAN


The clinical research director of the UCSF Multiple Sclerosis Center discussed the early-onset progression in multiple sclerosis and emphasized the need for targeted therapies in this patient population. [WATCH TIME: 6 minutes]

WATCH TIME: 6 minutes

"Once you develop highly effective therapies, which we have, you suppress the relapsing activity and guess what you see? This insidious decline in function that begins very early on."

In a previously reported prospective cohort, more than half of the participating patients with relapsing multiple sclerosis (MS) accumulated a significant new disability by 10 years of follow-up and using no evidence of disease activity did not predict long-term stability at 2 years.1 Published in Annals of Neurology, a prior study showed that long-term worsening was common among patients with relapsing MS, was largely independent of relapse activity, and was also associated with accelerated brain atrophy.2 Based on these findings, lead author Bruce Cree, MD, PhD, MAS, FAAN, and colleagues proposed the term “silent progression” to describe the insidious disability that accrued in several patients who fit the traditional criteria for relapsing-remitting MS.

At the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee, Cree will participate as a speaker in a symposium surrounding silent progression in MS. Other expert speakers will include Gabriel Pardo, MD, founding director of the Multiple Sclerosis Center of Excellence at Oklahoma Medical Research Foundation, who plans to talk about biomarkers in MS. In addition, Irene Cortese, MD, director of the Experimental Immunotherapeutics Unit at National Institute of Neurological Disorders and Stroke, will speak on progressive multifocal leukoencephalopathy and Corey C. Ford, MD, PhD, professor of neurology at the University of New Mexico, will chair the speaker event.

Prior to the symposium, Cree, the clinical research director of the UCSF Multiple Sclerosis Center, sat down in an interview with NeurologyLive® to discuss a little about what he plans to talk about at in the session, specifically on the future of MS therapeutics. In the interview, he spoke about the phenomenon of progression independent of relapsing activity in MS. Moreover, Cree explained how spinal cord imaging can help contribute to further understanding MS progression. Additionally, Cree shared his reactions to findings from recent clinical trials targeting progressive MS and spoke about the potential of studies in the future in this patient population.

Click here for more coverage of CMSC 2024.

1. University of California, San Francisco MS-EPIC Team:, Cree BA, Gourraud PA, et al. Long-term evolution of multiple sclerosis disability in the treatment era. Ann Neurol. 2016;80(4):499-510. doi:10.1002/ana.24747
2. University of California, San Francisco MS-EPIC Team, Cree BAC, Hollenbach JA, et al. Silent progression in disease activity-free relapsing multiple sclerosis. Ann Neurol. 2019;85(5):653-666. doi:10.1002/ana.25463
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