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AAN April 2008

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The American Academy of Neurology has a meeting each spring.  The meeting covers all of neurology and usually includes a lot of research on multiple sclerosis.  This year the meeting was in Chicago on April 15-17.   The presentations I found most interesting were: 

Vitamin D3 in multiple sclerosis.  Low levels of vitamin D may make MS worse.  Some vitamins are fairly safe at large doses, such as vitamin C, but others, like vitamins A and D, can be toxic if you take too much.  The recommended dose of vitamin D in adults is 400 IU per day.  These investigators gave up to 40,000 IU of vitamin D per day for short periods with no significant side effects.  The next step is to test whether vitamin D treatment helps reduce disease activity in MS.  For now, it is reasonable to take a supplement with the recommended amount of vitamin D. 

Copaxone at onset of MS.  The PRECISE study looked at whether treatment with Copaxone at first symptoms prevents the later progression to MS.  They found that they decreased the number of people having  a second relapse by 45%.  This was expected, since Copaxone reduces relapses in established MS.  Interferons have been shown to be effective for prevention of a second relapse previously.  It makes sense to start treatment with either Copaxone or interferon early in disease. 

Betaseron vs. double dose Betaseron vs. Copaxone.  The BEYOND study tested whether a higher dose of Betaseron would be more effective than the current dose, and compared the effectiveness of Copaxone and Betaseron.  This study included over 2000 patients.  There was no significant difference in relapse rates between the groups.  It appears that the currently marketed dose of Betaseron is optimum, and that Copaxone and Betaseron are of similar effectiveness.  This is similar to the results of a study comparing Rebif and Copaxone reported last fall.  

Daclizumab in MS.  Daclizumab is a monoclonal antibody which binds the interleukin-2 receptor, with multiple effects on the immune system.  This study involved 230 patients in 3 groups: placebo, low dose, and high dose.  All patients were also on interferon.  The addition of daclizumab reduced the number of active lesions on MRI scan during the 24 weeks on treatment, but the effect wore off rapidly when treatment was stopped.  This treatment will probably proceed to a phase III study. 

Alemtuzumab in MS.  This study has already been reported, but they present further followup.  This study compared alemtuzumab to Rebif, one of the standard MS treatments.  The relapse rate decreased by 74%, and the progression of disability by 71%.  These benefits were sustained through an additional year of followup.  The effectiveness is impressive, but side effects are significant.  This treatment is going in to the last phase of clinical testing, and may be a leading treatment in the future. 

J. William Lindsey, MD
University of Texas Multiple Sclerosis Research Group
Houston, Texas

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