Michael Hehir, M.D., Assistant Professor of Neurology (Photo: COM Design & Photography)
When University of Vermont neurologist Michael Hehir, M.D., treats patients with a relatively rare neuromuscular disorder called Myasthenia Gravis, he has to weigh the benefits of the medications he prescribes against their typical side effects.
That’s not an easy balance to strike, says Hehir, an assistant professor of neurological sciences, who specializes in the autoimmune disease that causes weakness and rapid fatigue of muscles in adults and children. The stakes are high for patients; muscle dysfunction due to myasthenia gravis can threaten livelihood, impair the ability to drive, affect the ability to care for children and other loved ones, impact school performance for pediatric patients, limit leisure activity, and in the most severe circumstances, result in hospitalization.
Hehir wonders how can he compare, for example, the minimal risk that one drug will cause a serious infection that puts the patient in the hospital against the strong likelihood that another drug will cause the patient to gain weight? And what if the drug with potentially more dangerous consequences is more effective at mitigating the patient’s disease?
This is the challenge he has set out to address with his current research project, which was recently funded through a three-year Clinician-Scientist Development Award in Myasthenia Gravis and Related Disorders of the Neuromuscular Junction from the American Academy of Neurology, American Brain Foundation, and Myasthenia Gravis Foundation of America (MGFA). The study involves the creation of a metric – a mode of currency that Hehir can apply to various side effects from different medications – in order to compare medications equitably.
In this system, the possibility of a serious infection would carry a high score, while weight gain would incur fewer points. The scoring system reflects input from both patients and physicians, Hehir says.
“We want to weight it so the things that are really the most life-altering or most severe get the most points,” he says. “That’s the goal.”
Hehir recently was named 2016 Doctor of the Year by the MGFA, a volunteer organization dedicated to finding a cure and better treatment for Myasthenia Gravis and related disorders. He also serves on the foundation’s Medical/Scientific Advisory Board.
“Mike is always at the ready to help provide information, ideas and support to MGFA and the MG community,” says Kathleen Brown, the foundation’s national program director.
In the U.S., about 20 of every 100,000 people is diagnosed with Myasthenia Gravis, according to the MGFA. Despite the rarity, Hehir follows 100 to 150 patients with the disorder, from as far away as Maine and upstate New York. Two of Hehir’s patients helped organize Vermont’s first Myasthenia Gravis Walk for awareness in September 2015.
Hehir focuses on finding the right medications “to improve their strength and cause the least amount of side effects,” he says. The steroid prednisone, for example, is often a first choice for treating MG, but also commonly leads to weight gain and sometimes diabetes, high blood pressure and bone problems. Immuno-suppressants are another option but carry the risk of opportunistic infections.
The MGFA award will allow Hehir to spend 80 percent of his time on his current research project. Next, he plans to put the side effects metric system into practice to see how well it measures patients’ quality of life on one drug or another, as well as evaluate each drug’s effectiveness at treating the disease. Hehir is also is leading 14 medical centers in a clinical trial that is looking retroactively at the experience of patients with a rarer form of antibody-specific myasthenia. If his system works well for evaluating medications to treat Myasthenia Gravis, it could provide a tool to compare treatments for other diseases, Hehir says.
“Certainly, we physicians make these decisions every day,” Hehir says. “It gives you a really rigorous way to evaluate things that’s not currently available.”
Read a UVM Medical Center blog post about the Vermont Myasthenia Gravis walk and Hehir’s work.