A UK clinical trial is testing whether rapid treatment with a highly effective multiple sclerosis (MS) drug (within just two weeks of the first presentation) could change the course of the disease.

The AttackMS trial, led by Professor Klaus Schmierer at Queen Mary University of London, is the first study to treat individuals with suspected MS at the first demyelinating event with such a short delay using a highly effective DMT. The aim? To protect brain health from the outset and prevent long-term disability. The underlying concept is to enable “living with MS but hardly affected by it”.

A Common condition, in which diagnostic delays are costly

More than 150,000 people in the UK live with MS, and every year 7,000 new diagnoses are being made of this chronic disease where the immune system attacks the central nervous system. The most common type — relapsing MS (RMS) — accounts for around 80% of initial diagnoses. Early symptoms may include a “wobbly leg”, sensory disturbance from the feet upwards, blurred or double vision. Detecting these symptoms as potentially related to MS can be difficult, leading to delays of effective intervention during which irreversible nerve damage may already occur.

Trialling a Highly Effective Early Treatment

AttackMS is testing Natalizumab (Tyruko®), a widely used and highly effective immunotherapy for people with “rapidly evolving” RMS. It blocks immune cells from entering the brain and spinal cord, thereby halting the inflammation that drives MS progression. In AttackMS, participants are randomly assigned to receive either Natalizumab or placebo for 12 weeks, followed by an additional 12 weeks in which all participants receive the active drug. MRI scans are used throughout to monitor changes in lesions—areas of damage in the brain or spinal cord—providing insight into the potential for repair, and the importance of rapid intervention.

What makes AttackMS quite unique is that a confirmed diagnosis of MS is not required to participate. Individuals presenting with a clinically isolated syndrome (CIS) and at least two demyelinating lesions on MRI brain—one of which is recent or linked to current symptoms—are eligible. This approach could herald a major shift in treatment philosophy: acting at the earliest stage, when the brain has the greatest capacity for repair, rather than waiting for irreversible damage to accumulate.

Fast Action for Better Outcomes

In current practice, many patients face months of uncertainty before receiving treatment. The AttackMS team believes that intervening earlier will protect long-term brain function and prevent disability.

“We believe treating MS as soon as possible – even before a definite diagnosis – could prevent damage and give people better long-term outcomes,” says Professor Schmierer. “Our hope is that AttackMS will spark a change in how we approach MS from the very beginning.”

Understanding the Science Behind Early Intervention

Multiple sclerosis is a disease of immune-mediated demyelination, where the protective myelin sheath around neurons is attacked by the immune system. This leads to disrupted nerve conduction, inflammation, and axonal loss. Recent studies suggest that irreversible damage can occur during the very first demyelinating event, even before MS is formally diagnosed.

The rationale for using Natalizumab in this early stage lies in its mechanism of action. It is a monoclonal antibody that targets α4-integrin, a molecule involved in immune cell migration. By preventing lymphocytes from entering the central nervous system, Natalizumab helps to halt the immune response at a critical moment — potentially preserving tissue integrity and allowing natural remyelination to occur.

MRI has become central to both diagnosis and disease monitoring in MS. In AttackMS, researchers will use MRI to track lesion and brain volume, as well as a technique called magnetisation transfer ratio (MTR), from which the myelin content in the brain can be inferred. A higher MTR value over time may signal myelin repair.

Building a New Model of MS Care

The AttackMS trial is also part of a broader vision for rethinking how and when MS should be treated. Currently, most healthcare systems around the world wait for diagnostic certainty before offering DMTs. However, this approach may miss a critical window of neuroprotection. If AttackMS proves successful, it could provide the evidence needed to justify a paradigm shift — one where MS is treated more like stroke or myocardial infarction: urgently, and without hesitation.

This may include the creation of “hyperacute MS units” embedded within existing neurology departments or emergency settings. These units would be equipped to rapidly assess patients, perform MRI, initiate treatment, and arrange follow-up — all within days of their first symptom(s). Such a model could help reduce long-term disability, preserve workforce participation, and reduce the socioeconomic burden of the disease.

Support and Collaboration

The trial is sponsored by Queen Mary University of London (QMUL), and funded by Sandoz. It also benefits from collaboration with the MS Society of Great Britain & Northern Ireland and the NIHR Clinical Research Network. AttackMS is being delivered through QMUL’s Pragmatic Clinical Trials Unit (PCTU)

AttackMS has been developed in collaboration with the MS community, and people with MS are members of both the trial management and steering committees. Informed consent, safety monitoring, and transparency are all integral to the study design. Volunteers receive high-resolution MRI, regular clinical assessments, and personalized follow-up, making participation a potentially beneficial and informative journey.

Trial Reopening After Funding Pause

The trial recruited 11 participants in 2023 before pausing due to a change in funder. With new support from Sandoz, the study has now reopened and is actively recruiting again.

To be eligible, participants must:

• Be aged 18 to 55
• Be experiencing their first symptoms suggestive of MS
• Have an MRI scan showing relevant findings
• Be seen within 14 days of symptom onset
• Be able to travel to London for study visits

Interested in Joining?

If you or someone you know is experiencing early MS symptoms please contact the AttackMS team directly at bartshealth.attackms@nhs.net.