Autoimmune Disorders Care Through Research and Results: The Mayo Clinic Way

Here is a summary of the 3-M Approach which is the Mayo Clinic Way of supporting people with Autoimmune disorders. As the name suggests there are three parts to their treatment approach.

The 3-M Approach 

On top of the research being conducted, the neuroimmunology laboratory has adopted a new model of care Pittock calls the “Mayo Clinic 3-M” approach. 

Sean J. Pittock, MD, is the director of the Mayo Clinic Center for MS (Multiple Sclerosis) and Autoimmune Neurology.

The first M stands for “Maximize reversibility.” Here, patients are given large doses of immunotherapy over a short period of time, with maximum reversibility measured through phenotype-specific evaluations. Pittock gave several examples of patients, saying, “If you come in with epilepsy, we count your seizures, or we do epilepsy monitoring. We give you your therapy, we measure, and then we get a sense of that big treatment trial." 

The second M is "Maintaining maximum reversibility." Once a patient has reached a point where they have shown progress with their treatment regimen, it becomes a question of maintenance because patients cannot be given steroids in perpetuity, Pittock explained. The next step is to select an immunotherapy that spares agents such like steroids and other choices like intravenous immunoglobulin, and use other drugs including rituximab, methotrexate, and in other cases, other drugs, such as IL-6 inhibitors like satralizumab. 

 

The third M is "Minimum dose of immunotherapy" to lower risk of adverse effects while maintaining the maximum reversibility. Patients on immunotherapy may experience a range of these, from flu-like symptoms such as fever, chills, weakness, nausea or vomiting, fatigue, headache, or trouble breathing, to other adverse effects including swelling and weight gain, heart palpitations, diarrhea, organ inflammation, and infection. 

 "What do we still need to work on? We discussed biomarkers and the immunopathology, but we still need to work on the treatment part," Zekeridou said. "The NMO example is a perfect example, but the thing the NMO trials has taught us is that we cannot do it alone. These trials were multicentered around the world. We’re dealing with rare diseases, so we need this kind of collaboration. We also need to do a better job of advocating for our patients until we have FDA-approved drugs. This is something we see in our clinic every day, where patients will not get insurance for specific treatments, even though they do have autoimmune encephalitis."

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