ECTRIMS 2021
The annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis was held virtually on October 13-15. Due to the 7 hour time difference, I viewed most of the sessions a few days after the live presentations. There was the usual abundance of fascinating and cutting-edge research presentations. I will briefly summarize the presentations most relevant to people with MS. Another CD20 antibody. There were presentations on two treatments of particular interest. One is the results of a phase III trial of ublituximab, a monoclonal antibody to CD20. Ublituximab was compared to teriflunomide (Aubagio), and had the expected significant effects on relapses and MRI activity. There are already two approved treatments which target CD20, ocrelizumab (Ocrevus) and ofatumumab (Kesimpta), so this will be a third option when it is approved. Mesenchymal stem cells. A second presentation that will be of great interest to the MS community was the Cleveland Clinic trial of mesenchymal stem cells in progressive MS. The stem cells were obtained from bone marrow, and administered into the spinal fluid in three different infusions. They treated 18 patients, and observed encouraging changes on various inflammatory and protective biomarkers and on clinical measures. There was no control group, so we don’t know if the observed changes are a real effect of treatment. Stem cells in MS will require a lot more work to figure out if there is a benefit. Most other studies of stem cells have given them into the blood, and we don’t know if blood or spinal fluid will be better. Remyelination. Some disappointing news was reports of two different monoclonal antibody treatments to improve remyelination and regeneration. Neither opicinumab nor elezanumab had a significant benefit for improving MRI or clinical measures. These two trials are some of the first large scale studies of remyelinating treatments intended to improve existing symptoms. All the currently available disease modifying treatments decrease new disease activity, but don’t fix previous damage. Covid. As expected, there were multiple presentations on Covid and MS. The risk factors for poor outcome from infection in MS are pretty much the same as for the general population, such as age, obesity, diabetes, and pre-existing lung disease. People with more severe disability from MS are also at increased risk. There is an emerging consensus that people on CD20-depleting treatments (Ocrevus, Rituxan, Kesimpta) are at increased risk of severe infection, but this is complicated by the fact that people on these treatments also tend to have more severe disability. Covid vaccines. The effect of different MS treatments on the response to covid vaccines was the subject of several talks. The antibody response is decreased in people on CD20-depleting agents or S1P inhibitors (Gilenya, Mayzent, Zeposia, Ponvory). This decrease in antibody response is expected since the cells that make antibodies are the B lymphocytes that express CD20. In spite of the decreased antibody response, the cellular or T lymphocyte response were still robust and likely offer good protection against infection. People on the B cell depleting treatments should definitely get the vaccine. Relapse versus progression. A final presentation of interest was an investigation of whether most disability in people with relapsing MS is due to relapses or to progressive symptoms. We often focus on relapses or exacerbations because they are dramatic and noticeable. But progression independent of relapses contributed more to disability.