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.

Scientific topics:There were two topics discussed that particularly interested me. One is remyelination, which wasdiscussed in several sessions. This is an area that is getting increasing attention as the scientificunderstanding of the process of remyelination increases and treatments are being attempted. Thisis 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 asclemastine and liothyronine, are being repurposed for possible remyelinating properties. TheCharcot award this year was given to Dr. Lubetzki, who discussed her extensive work onremyelination and the cells involved.The other area I found interesting was the session on immune tolerance. The idea here is that youidentify the target of the autoimmune attack in MS and then devise a way to specifically regulate thecells of the immune system that are attacking that target. This would be a way to really benefit MSwithout 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 presentationdiscussed the ETIMS trial, which was intended to induce tolerance to 3 myelin proteins. Smallpieces of the proteins were attached to red blood cells and injected back into the patient. This didinduce tolerance to the proteins and had no obvious ill effects. There was a suggestion of adecrease in relapses, but this was a small, phase I trial so any conclusions about effect on diseaseare preliminary.Treatment studies: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 agentsfingolimod (Gilenya) and siponimod (Mayzent). It was compared to teriflunomide (Aubagio) and hadthe expected effects on relapses and MRI activity. The advantages are that it is more specific thanthe 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 weeksinstead of by intravenous infusion. This may be more convenient in practice. There were twoidentical 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 becomparable to ocrelizumab infusions.A “Hot Topics” session was devoted to discussion of bone marrow transplant, also known asautologous 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 foraggressive MS, but the risks remain concerning, and it doesn’t appear to help in progressivedisease.Stem cell treatment was also discussed. Dr. Uccelli presented the results of the MESEMS trial, inwhich 144 patients received infusions of stem cells, either into the blood or the CSF. The cells werederived from the patient being treated. Some patients were treated at entry into the trial and othersafter 6 months. There was no effect on MRI measures, but there was a small decrease in relapseswith treatment. Dr. Karussis reported his experience with stem cell treatments which was muchmore positive. He treated 48 patients with progressive MS with injections of stem cells either intothe blood or the CSF. Fewer patients in the treated group had worsening of disability, and theinjections into the CSF appeared more effective than injections into the blood. This was a smallstudy lasting only 6 months, and needs to be replicated in a larger group.