I attended the 2019 ECTRIMS meeting in Stockholm from September 11 to 13. There were a number of things I found interesting, and it was nice to get out of the Houston heat for a few days. I will start with the more scientific presentations, and then discuss trials of new therapies for MS.
There were two topics discussed that particularly interested me. One is remyelination, which was
discussed in several sessions. This is an area that is getting increasing attention as the scientific
understanding of the process of remyelination increases and treatments are being attempted. This
is something that we need to understand if we are going to promote recovery after damage in MS.
One complete session and several other talks were about what needs to happen for remyelination,
what cell types are involved, and how to promote remyelination. Some existing drugs, such as
clemastine and liothyronine, are being repurposed for possible remyelinating properties. The
Charcot award this year was given to Dr. Lubetzki, who discussed her extensive work on
remyelination and the cells involved.
The other area I found interesting was the session on immune tolerance. The idea here is that you
identify the target of the autoimmune attack in MS and then devise a way to specifically regulate the
cells of the immune system that are attacking that target. This would be a way to really benefit MS
without immune suppression or side effects. This presently is more an idea than a reality, but Dr.
Wraith presented some very interesting work on ways to induce tolerance. A separate presentation
discussed the ETIMS trial, which was intended to induce tolerance to 3 myelin proteins. Small
pieces of the proteins were attached to red blood cells and injected back into the patient. This did
induce tolerance to the proteins and had no obvious ill effects. There was a suggestion of a
decrease in relapses, but this was a small, phase I trial so any conclusions about effect on disease
In the area of new treatments, there were two reports on drugs that are likely to be available soon.
Both were new forms of existing treatments. Ponesimod is similar to currently marketed agents
fingolimod (Gilenya) and siponimod (Mayzent). It was compared to teriflunomide (Aubagio) and had
the expected effects on relapses and MRI activity. The advantages are that it is more specific than
the two drugs already available, and the initial dosing strategy did not require observation.
The other major trial was ofatumumab, an antibody against B cells, similar to ocrelizumab
(Ocrevus). The major difference is that it was given by subcutaneous injection every 4 weeks
instead of by intravenous infusion. This may be more convenient in practice. There were two
identical studies done at the same time, with teriflunomide as the comparator, and a total of about
1800 subjects involved. The effects on relapses and MRI activity were robust, and appear to be
comparable to ocrelizumab infusions.
A “Hot Topics” session was devoted to discussion of bone marrow transplant, also known as
autologous hematopoietic stem cell treatment. There have now been 6 published trials, and Dr.
Burman from Uppsala presented a recently completed study. This is a very effective treatment for
aggressive MS, but the risks remain concerning, and it doesn’t appear to help in progressive
Stem cell treatment was also discussed. Dr. Uccelli presented the results of the MESEMS trial, in
which 144 patients received infusions of stem cells, either into the blood or the CSF. The cells were
derived from the patient being treated. Some patients were treated at entry into the trial and others
after 6 months. There was no effect on MRI measures, but there was a small decrease in relapses
with treatment. Dr. Karussis reported his experience with stem cell treatments which was much
more positive. He treated 48 patients with progressive MS with injections of stem cells either into
the blood or the CSF. Fewer patients in the treated group had worsening of disability, and the
injections into the CSF appeared more effective than injections into the blood. This was a small
study lasting only 6 months, and needs to be replicated in a larger group.