A global research team led by The University of Notre Dame Australia School of Medicine’s Professor Merrilee Needham, in collaboration with Perron Institute, Fiona Stanley Hospital and Murdoch University, is investigating the use of a re-purposed drug (Sirolimus) in the treatment of the rare disease Inclusion Body Myositis (IBM).
IBM is a muscle-wasting disease, leading to weakness in the arms and legs, weakened grip, issues with swallowing, and often results in patients requiring full-time care and assistance for all daily activities. Over 60 per cent of those diagnosed lose independent mobility within seven-to-ten years of symptom onset, and as the disease usually manifests in middle to late life, the impact of this disease is significant for both patients and their families. The gradual loss of muscle strength and mobility patients experience whilst retaining cognitive function invokes significant uncertainty and anxiety, with this disease robbing people of independence and control.
IBM Patient Dennis O'Connell at home
There are currently no disease-modifying treatments for IBM, meaning the current clinical management of the disease is just supportive. This includes physiotherapy, exercise programs and pain management, which can offer some respite and purpose for patients, but the progressive nature of the disease means their eventual decline is an inevitability.
As is often the case with conditions that result in a need for increased care, depression and anxiety are common amongst patients, their partners, and their extended support networks. Additionally, the lack of awareness of this disease contributes to a sense of helplessness in patients. When there is no perceivable chance of future improvement, hope rests in finding a treatment that will change this natural history. This is the role of research and clinical trials.
As a patient impact statement from the Myositis Association Australia put it, “An effective treatment for IBM would, above all, offer us some future hope, which is non-existing at present.”
In response to the challenge of seeking a treatment for this rare, under-recognised disease, Professor Needham and a global team of experts recently received a MRFF grant to evaluate the clinical effectiveness of an immunosuppressant drug, Sirolimus. Currently primarily used to prevent organ rejection in post-kidney transplant patients, the team hypothesise that Sirolimus will stabilise or slow disease progression over an 88-week trial period. Sirolimus has been previously piloted in a small IBM cohort in France, with promising results.
Professor Needham called the approval of the grant a “landmark day for Inclusion Body Myositis patients around the world” and emphasised the collaborative global approach being taken to bring hope back to IBM patients.
“This is a planned global study to confirm this finding in IBM patients across Australia,” Professor Needham said.
“As well as involving patients from the USA, UK and Europe, with the goal of firstly confirming Sirolimus as the first disease-modifying drug for IBM sufferers, and secondly, by including all these sites, to change practice for all IBM patients around the world.
This study will be led from Australia to allow access for as many Australian IBM patients as possible, and we are so delighted to offer our patients a trial of a potential treatment, and more importantly, hope for their future.
The previously conducted pilot study from Paris has demonstrated the stabilising effect of Sirolimus on IBM patients, an encouraging result that has lent support to this larger trial which will hopefully confirm and validate these findings, offering conclusive data and potentially leading to international practice change and a first treatment for IBM.
The Myositis Association of Australia (MAA) and its members have been working tirelessly to help source funding for IBM clinical trials, including submitting a patient-led ‘Targeted Call for Research’ application to NHMRC in late 2019. President Christine Lowe said the MAA was “thrilled” to learn of the successful grant.
“IBM is a disheartening and insidious condition. Its relentless progression, causing loss of mobility, dignity and social connection presents a daily struggle. The lack of any effective treatment is a major unmet need and sadness for patients and families,” Mrs Lowe said.
“The Myositis Association Australia is thrilled to learn of this wonderful grant. We’re a group of volunteer patients and we all have Myositis. We support those affected by Myositis and also work to raise awareness. Encouraging funding for Australian research is important to us.
“Our IBM members are motivated by the hope of a breakthrough treatment. They’ve contributed to this funding journey - offering insights, often raw and heartfelt, describing the impact of IBM on their lives; advocating for funding assistance by attending meetings, requiring enormous personal physical effort and being open to engage with the clinical trial.”
Over 88 weeks, 140 IBM patients aged 45 years and older will receive either Sirolimus or a placebo and their progress monitored using the IBM Functional Rating Scale (IBMFRS). At least half of these participants will be enrolled from seven Australian sites, and results are expected to be disseminated by mid-July 2024.
Mrs Lowe praised the project team and highlighted how much of an impact this study is already having on the morale of IBM patients in Australia.
“We’re fortunate in Australia to have an excellent and collaborative group of willing ‘Myositis-experienced‘ doctors and researchers,” Mrs Lowe said.
“Our patients are buoyed by the reality of an Australian led clinical trial. The opportunity to participate, across the country, in testing a potential treatment for IBM is truly a gift of hope. We’re all grateful to everyone involved in the grant process.”
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