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The American Academy of Neurology meeting this year was held from March 18 to March 22, 2013.  As usual, there were a lot of reports from clinical trials and other results interesting for multiple sclerosis.

     Some of the more interesting new studies included two studies of different forms or dosing schedules for agents already in use.    A long acting form of interferon, given every 2 or 4 weeks, had benefits similar to the currently used forms of interferon, with no new side effects.  Glatiramer (copaxone) given at 40 mg three times a week decreased the relapse rate and MRI activity to a degree similar to that of the currently used dose, 20 mg daily.  These may be easier to use and tolerate, if approved for marketing by the FDA.  Also, a small study of vitamin D in MS patients with a low vitamin D level showed that you need a dose of 10,000 IU per day to increase the blood levels.
     There were numerous additional results or extension results from trials that have already reported their primary outcomes.  The primary results from the CombiRx trial of combined interferon and glatiramer were reported at AAN last  year.  Extension results were reported this year.  Although there was a small benefit of the combined treatments on the MRI measures, there wasn’t any difference in the groups on clinical outcome.  Daclizumab, a monoclonal antibody against the interleukin-2 receptor, continued to have impressive effectiveness in their extension study.  A second large phase III study of teriflunomide had results similar to the first study reported last year. 
     There were some interesting results on the scientific side also.  Dr. von Budingen compared the B cells found in spinal fluid and in the blood, and concluded that many B cells underwent maturation after moving from the blood to the brain.  There were also some excellent presentations on the effects of high salt on immune system function, with interesting implications for how the modern American diet may increase risk of autoimmune diseases.  Dr. George Ebers from Oxford received the Dystel Prize from the National MS Society, and gave an insightful lecture which pulled together many of his wide-ranging research studies over the last few decades on the environmental and genetic contributors to MS.  Many of these studies point to a low level of vitamin D as an important cause.

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

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