This year’s Guthy-Jackson NMO Patient Day in LA focussed on clinical trials. In the last year or so, there have been THREE clinical trials for NMO launched. In the world of rare disease, this is HUGE! It means there are drug companies out there that are willing to spend the time and money necessary to explore the possibility of new medications to prevent, treat and cure NMO. It’s a giant step forward for an orphan disease and it would not be possible without the hard work of everyone at the Guthy-Jackson Foundation.
So what does that mean, really? To put it simply, it means that we as patients need to step up. The clinical trials mean absolutely nothing unless NMO patients enrol. Because we are rare, the pool of possible trial subjects is already limited. If you add to that the possibility of some candidates being excluded for various medical reasons (there is strict medical criteria that must be met by each potential subject, for safety reasons) that further limits the number of patients who can participate. In order for a clinical trial to be viable, there are a minimum number of participants that must be met to make the results statistically significant. Without our participation, it is impossible for the medical science around NMO to move forward.
Having more treatment options for NMO is important. All of the current treatments for NMO are using drugs developed to treat other diseases. This means that while they might be helpful in the treatment of NMO, they are not specific to NMO and many of us fail on these drugs-we continue to have attacks and/or experience serious side effects which lead to us being unable to continue taking them. Having options is essential, which is why participating in clinical trials is imperative.
Last November, I attended NMO Patient Day at UBC and had the opportunity to get information about the clinical trials. I went over the information I received a number of times, I thought about it, I did my homework by digging up even more information online and I talked to people I trusted about it. When I was at LA for Patient Day in March, I had the opportunity to ask the experts more questions. After much consideration, I chose to screen for one of the trials. It was not a decision I came to lightly, but it was the right one for me.
Right after I got home from LA Patient Day, I was scheduled for my first screening appointment. I met with the clinical trials team from UBC to fill out the paper work which included a medical history and signing the informed consent and then I had a number of tests to complete.
There was a blood draw which made me laugh when Monica, the lab tech emptied a box of vials onto the counter. I did a quick count and discovered there were FORTY in total! Vampires! Fortunately many of the vials were small and used to break up the sample into smaller quantities, so I didn’t actually have to be siphoned! There was also a TB test so blood was put on a glass slide. It only took a couple of minutes and was pretty painless. Monica was super nice, so I really didn’t mind.
I had a physical with the neurologist who oversees the clinical trials which took about 20 minutes. Nothing exciting to report there-he listened to my heart, took my blood pressure and temperature and all the standard stuff. After that, I went across the hospital to have an EKG done. I walked those results back to the clinic and was free to go home. Part one of screening was done.
About a week went by and my blood results were in. I got a call from the clinical trials team telling me that one component of my blood work was not up to snuff and that they had been granted an extension of my screening time so that I could redo that part of the blood work and see if it improved. On my second screening visit, Monica redrew my blood and then I had a neurological exam by one of the neurology fellows. This was to determine my EDSS score. (Expanded Disability Status Scale which is the assessments of functional systems: Pyramidal (motor functions like walking), Cerebellar (coordination), Brain stem (speech and swallowing), Sensory (touch, vibration and pain), Bowel and bladder functions, Visual, Mental.)
From there, I went over to the hospital and had a head to tailbone 3 hour MRI with contrast. I am NOT a fan of MRIs, but the techs that were running it, Laura and Alex were so incredibly patient-focussed that for the first time ever, it was not a horrible experience. When it was over, I actually said “Thank you for making that not suck!” I was almost in tears and asked Laura if I could give her a hug. What made it so different from all the other MRIs I’ve had over the years is that they talked me through the entire thing. They would tell me how long a sequence was, whether the table was going to shift or not and in which direction, if the machine was going to vibrate and they would constantly be asking if I was okay and telling me I was doing a good job. Believe me that went a long way towards making me feel calm and cared for. They seriously need to be training other MRI techs how it’s done. Laura and Alex are exceptional at their job.
I still needed to have a neuro-opthomology assessment, but that was being scheduled after the second round of blood work came back. About a week later, I got an email from the clinical trials team saying that I had been excluded from the trial, by the slimmest of margins. In all honesty, I was stunned and frustrated that after all that, one tiny little thing meant I could not participate. I think for me, the hardest part of it was that some nameless, faceless stranger in another country got to make a decision about my health for me and there was absolutely nothing I could do about it. It’s taken a few weeks for me to digest that. I do want to say that the clinic trials team at UBC was excellent. I felt that throughout the entire process, they were kind, respectful and considerate. They were always willing to address any questions or concerns I had and did an exceptional job of communicating along the way. I have nothing but respect for the job they are doing. I know it’s not easy.
So would I do it all again, if I got a do-over? The simple answer is YES. I know how important clinical trials are and what it could mean to not just my life, but the lives of everyone living with NMO. At the LA Patient Day I heard so many people say that they were failing on their treatments or had run out of treatment options. This is not okay. This is life and death we’re dealing with here. I want us to have options for treatment. I know we have the best and brightest minds working tirelessly to unravel the mystery that is NMO and because of that, I do not hope for a cure-I EXPECT one. In the meantime, I believe we need treatments that will help us maintain or improve our quality of life and the only way we are going to get them is by participating in clinical trials.
Here’s a video from LA Patient Day that explains how clinical trials affect us as NMO patients.
That said, obviously I know that not everyone can or should participate in clinical trials. If you can’t, for whatever reason, you still have the power to make a difference: sign up for research studies. The CIRCLES study is an excellent way to partner with NMO scientists all over the world. It’s a simple blood draw any time you are able to connect with your collection site. Mine is at UBC, where I see my neurologist, so any time I am booking an appointment, I make sure it will coordinate with having blood drawn for the study. At my clinic CIRCLES blood can only be drawn Monday through Thursday prior to noon, in order for it to be shipped to the biorepository in the US. I book my appointments specifically to accommodate this schedule. Sometimes I am out at UBC for other reasons and I will email the CIRCLES team and say “Hey, I’m on campus this week. Would you like some blood?” They always say yes. It’s never more than 20 minutes of my time and it’s that simple.
There is an excellent video from LA Patient Day about Your BioBank at Work that explains how the blood from CIRCLES is used and the difference it makes. It’s worth watching.
I have also taken part in other types of studies. The most recent one was an NMO and cognition study that involved doing some simple game-like tests for the first part and then an hour brain MRI for the second part. I had the brain MRI about 2 weeks ago and had the same fabulous techs, Laura and Alex who did my clinical trial screening MRI. After my initial experience with them, I trusted them completely and for the first time ever, had ZERO anxiety having the MRI done. That was amazing! When it was all done, Alex handed me a disc with my MRI on it. I was both surprised and pleased. My UBC Health Mentor students will enjoy seeing it. It was a lovely thing for him to do. You get what you give!
All NMO research is important. The information gathered helps researchers and clinicians piece together a better understanding of this disease and its effects. It just takes one small thing to unlock the mystery and find the cure and we can all be a part of that process. I encourage you to consider participating in whatever way you feel comfortable. We have the power to help end this terrible disease. Together, let’s say YES to cure NMO!
To learn more about NMO Clinic trials, please visit the Guthy-Jackson Foundation Clinical Trials FAQ page.