I attended the annual meeting of the European Committee for Treatment and Research in MS in Berlin from October 10-12, 2018. This is the largest meeting devoted to MS, with about 10,000 participants, 300 platform presentations, and 1500 poster presentations.

One focus of this years meeting was progressive MS. There were a number of talks on themechanism of damage in progressive MS, and some talks on treatment. There is currently notreatment which has a marked benefit in progressive MS, and there is increasing interest in findingnew treatments for this type of MS along with better ways to measure changes in progressive MS.A study done in the UK with three drugs already approved for other uses; fluoxetine, amiloride, andriluzole; had negative results.Another focus was risk management for current treatments. Two useful and reassuringpresentations reported on death rate and cancer risk with some of the highly effective MStreatments that I currently use. There was no significant increase in the death rate with rituximab,and there was no signal for an increase in any type of cancer, and in particular no increase in risk ofbreast cancer with rituximab. The current label for ocrelizumab raises the question of increased riskof breast cancer, but it seems unlikely that is a real cause and effect relation since it was not seen inthe much larger rituximab group. Rituximab and ocrelizumab are very similar, and I expect theyshould have the same risks.Unlike previous years, there were very few clinical trial results and very few completely newapproaches to treatment. The main exception is the study of the tyrosine kinase inhibitorevobrutinib. This drug inhibits a protein found in B cells and macrophages that is important forregulation of immune responses. In the phase II study, it had encouraging results on MRI activityand possibly clinical relapses over 24 weeks. The phase III study is currently beginning, and thiswill be an interesting drug to watch.My major research interest is the role of Epstein-Barr virus in MS, and there were a fewpresentations on this topic. Dr. Olsson reported that a protein called anoctamin-2 cross-reacts withthe EBV nuclear antigen, and that a significant fraction of MS patients have an antibody againstanoctamin. Increased antibodies against anoctamin predict risk of MS in the future. Dr. Klemensreported that in a large cohort of new MS patients from Germany, all persons were infected withEBV. This supports the idea that infection with EBV is required to get MS. One poster reported thatMS patients with more active disease were more likely to have a high level of antibodies againstEBV, and another reported that many of the cytotoxic T cells in MS brain are specific for EBV.