Why stroke patients don’t get the treatment they deserve

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Despite improvements in stroke survival rates in recent decades, research into rehabilitation and recovery has lagged behind.

NR Times speaks to Dr Hamzah Baig, vice president of Global Medical Affairs at biopharmaceutical firm, Ipsen, about its efforts to address this.

Thirty years ago, scientists working in a UK government defence facility discovered a neurotoxin —originating from the bacteria botulinum— which they realised could have medicinal uses.

From this a drug was developed which in the years since would be used in various ways for the treatment of movement disorders.

Today, botulinum toxin injections also known as Dysport®(abobotulinumtoxinA), are prescribed to help manage spasticity in stroke patients.

However, despite having access to this drug for the last three decades, there has been little movement in the rates of rehabilitation among stroke survivors.

Stroke remains the second leading cause of death and the third leading cause of combined death and disability across the world.

This is a key area of focus for global biopharmaceutical firm, Ipsen, the manufacturer of Dysport®.

Vice president of Global Medical Affairs, Dr Hamzah Baig, leads a team of scientists and physicians who conduct clinical trials in partnership with key research institutions across the world with the aim of improving patient care.

In this exclusive interview with Dr Baig, he shares his insights on why research into stroke rehabilitation has been neglected, the challenges facing physicians in this sector and what the future of stroke care should look like.

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Dr Hamzah Baig, vice president of Global Medical Affairs, Ipsen.

Could you start by giving us a brief introduction to yourself and how you came to be in your current role with Ipsen?

Of course. I'm a physician myself, I was born and raised in the UK and worked in the NHS for several years where I was a doctor in internal medicine. I've been working in the pharmaceutical industry for about 15 years now and I’ve been with Ipsen for the last four and a half, where my area of focus is neuroscience. I lead a team of people who carry out clinical trials and data generation on behalf of the company, but we work in partnership with a lot of academic centres and professors around the world.

What can you tell us about the work you are doing around stroke medicine and rehabilitation?

I often think that the area that we work in, and the drugs that we work with, are very different from your typical pharmaceutical. A lot of the studies that we run may not necessarily be related to a specific medicine.

For one example, we have a global study called EPITOME, which is trying to capture data from all patients who've had a stroke to understand the epidemiology of which of those would benefit from pharmacological treatment further down the line.

A lot of the work that we're doing at the moment is trying to understand why people who have had a stroke don't get the treatment they deserve. I don't just mean the medicine that we produce, but in a broader sense. I think we have a mission to try and understand that a little bit better.

"It’s really incredible that most people who have a stroke and experience spasticity don't get the treatment they deserve now."

Can you expand on what you mean by patients not getting the treatment they deserve?

What was really surprising to me joining the company, is that after 30 years we don't seem to have made much headway in terms of treating people after they have experienced a stroke. It seems to be one of those neglected or forgotten areas.

It’s really incredible that most people who have a stroke and who experience spasticity, don't get the treatment they deserve now. I say this from a personal perspective, because my mother had a stroke when I was very young and she suffered from spasticity. This drug wasn't available then, but you'd like to think that 30 years on if the same thing happened that she would get access to this treatment.

Why do you think progress has been slow?

We work really closely with the World Stroke Organisation, and to be fair to the professionals working in this area everyone has been focused on how we help people survive and recover from the initial stroke, while preventing recurrent stroke. That's where all the research and funding has been, and there have been some incredible breakthroughs in terms of how stroke is treated, even in the last 10 to 15 years.

Subsequently though, more people are surviving strokes. With more people surviving there are more people who now have to deal with the consequences of having had a stroke as part of society. It's not a disease that only affects the very elderly, there are people of working age who could go back to work if they had the right treatment or the right support system around them.

"We're trying to encourage that connection between the medical doctors, but also the physiotherapists, who play a very strong role in rehabilitation."

What are some of the challenges in stroke care? And what is your take on how we tackle them?

I think the biggest problem we have is that people seem to be lost in the system. Patients are treated for their acute stroke, then some go to a rehabilitation centre, some go to primary care and some go straight to a nursing home, depending on the severity of the stroke. Education is something that can play a key role, in terms of noticing the signs of spasticity and what treatments are available.

One of our biggest themes at the moment is connecting rehabilitation services with stroke units because they are different professionals, with different disciplines. If we're thinking particularly about the UK, for historical reasons, rehabilitation hospitals are not always in the main acute hospitals, so physically and professionally these disciplines seem to be disconnected.

We're trying to encourage that connection between firstly, the medical doctors, but also the physiotherapists who play a very strong role in rehabilitation.

What has your research shown so far in terms of solutions to improving stroke care?

We do some really diverse studies, that are not just about whether medicine is working or not, but are focused on listening to the patients, understanding the healthcare system and trying to come up with evidence-based reasons to enhance healthcare.

The headline that's come out of studies such as AboLiSh for us, is things like if you use guidance techniques you can get better outcomes, something that was never really seen before in the data but was a matter of debate in scientific circles.

We also did another very interesting study where we worked on getting patients to really understand their treatment journey. We realised that across several areas, not just spasticity but also dystonia, a lot of people were being put into a rigid regime where you could only come in at certain times to get your treatment. We saw that actually their symptoms were coming back before they were treated and we weren't personalising care to make sure they had the best coverage of treatment in between their injections.

Technology can obviously play an important role in improving rehabilitation outcomes, what work are you doing around this?

Technology has moved on so much, but the health problems are still the same. For us, it's all about how we help people to get the best out of our medicines. We can use some of these technologies, such as machine learning and AI to diagnose—or as a companion diagnostic to physicians—to allow for more consistency in terms of outcomes rather than relying on the physician's experience which may vary from place to place.

If there's any profession that should be readily able to adapt to these new technologies, it's rehabilitation because those in the field are used to working with robotics and devices and they have a very physical way of approaching complex disease.

"If there's any profession that should be readily able to adapt to these new technologies, it's rehabilitation."

There's going to be a lot of movement in this area very soon and I think where we can play a role is linking those technologies with the treatment in larger studies, which will drive adoption. We also have a network of expats across the world who are always happy to be involved in running training programmes.

What key things do you think professionals working in the sector need to consider to improve stroke care moving forward?

The first bucket is what I call, the acceleration of diagnosis—not just connecting patients from their initial stroke to their rehabilitation needs from a timeline perspective, but also getting to the nub of what their needs are.

The standardisation of approach I think is really interesting: what treatments do we give, at what time point and how do patients and doctors ensure consistency so that it doesn't really matter where you go, you're getting your needs met.

And then, finally, long-term holistic patient care. We did a review of the French PMSI database recently (which is part of one of our observational retrospective studies) and we realised that a lot of patients would have one cycle of treatment and wouldn't continue. But most of our experts would say that you need at least a year, or two or three cycles of treatment to understand if you're getting the benefit. So, why are people dropping out so early? I think that's a huge question to answer.

"It’s still early stages now, but I think we've got many years of being in this space and the potential is enormous."

Are there any upcoming developments at Ipsen which you are particularly excited about?

We are starting a new study where we will use psychological questionnaires to understand the needs of the patients and their carers, and why they might potentially not adhere to treatment.

We build really strong research and early development capability and in-house we have developed a new generation of neurotoxins that could potentially have a longer duration of effect which could have real benefits to patients. They can spend more time focusing on rehabilitation and less time coming for treatment.

It’s still early stages now, but I think we've got many years of being in this space and the potential is enormous.

Why stroke patients don’t get the treatment they deserve—and what we’re doing to change it