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The annual ECTRIMS meeting was October 13-16.  This is one of the larger academic meetings on multiple sclerosis.  Here are the results which I found most interesting. 

Treatment
The results from a number of clinical studies of new treatments for MS were reported.  There was one phase III study.  Studies in phase III are designed to definitively demonstrate whether a treatment works or not.  There were also numerous phase II studies.  Phase II studies are intended to test safety, find the best dose, and get an idea whether the drug being tested is likely to work. 
The major report was the results of a phase III placebo-controlled trial of teriflunomide.  This is an oral immunosuppressive drug which is very similar to a drug already in use for rheumatoid arthritis.  The relapse rate was reduced by 30%, and the number of patients with progression of disability also decreased by 30%.  The amount of MRI activity decreased by 67%.  There were not any worrisome side effects.  I think this may end up being a useful treatment if the side effects remain minor, particularly since most of the more effective drugs have also proven to be more risky.  They have 3 other phase III studies now in progress, some of which combine teriflunomide with one of the other standard treatments. 
There were a lot of phase II trials reported.  There were two studies of different antibodies which eliminate B cells, similar to rituximab, which is also in testing for MS.  They are called ocrelizumab and ofatumumab.  Both of them showed an impressive effect on MRI activity.  I would expect their side effects and benefit to be similar to rituximab.  My concern with these agents is that there will be rare, but severe, infections.  We are using rituximab for other diseases similar to MS, and I expect that these anti-B cell antibodies will end up having an important place in MS treatment.  But we will need to wait for the results of further testing. 
Another interesting drug is firategrast.  This is an oral medication which is supposed to do the same thing that Tysabri does.  The highest dose tested decreased MRI activity by about 50%.  Side effects were minor.  The best dose may be higher than the doses they tested, and I will be interested to see what the long term side effects are. 
A study of the combination of a statin (the medicines for high cholesterol) with interferon resulted in interesting findings.  The patients on the combination treatment did worse than the ones on interferon alone.  There have been several studies of this combination, with variable results. 

Scientific results
CCSVI remains a controversial topic.  There were presentations which both supported and contradicted the relevance of venous occlusion for MS. 
The Genetics Consortium is now up to over 100 genes which contribute to the risk of MS.  Most of these have a very small effect. 
The pathologists continue to present interesting results.  One interesting talk claimed that inflammation was present in all active lesions, even in progressive disease, and that late in life MS may enter an inactive stage.  Inflammation versus degeneration has been an ongoing controversy. 
Biogen presented a thorough study of the prevalence of JC virus.  This is the virus that causes PML, the serious infection which may occur with Tysabri treatment.  About 54% of people are positive for infection with the virus.   This is potentially important, since the 46% of MS patients that aren't infected should be at very low risk of PML. 

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

copyright 2007-2017 John William Lindsey