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AAN 2014
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The annual meeting of the AAN was held April 28 through May 2 in Philadelphia.  There were a limited number of reports from clinical trials compared to previous meetings.

Clinical Studies: 

There were several presentations on different aspects of a sustained release interferon.  This is a new version of the interferon currently marketed as Avonex and Rebif, which is formulated to have a more sustained release.  The main outcomes of their clinical trial were reported last year, and demonstrated that administration every two weeks reduced relapses by 36% and progression by 38% over 1 year of treatment.  The new reports described other outcomes and the results of the extension study.  This looks like a more convenient way to use interferon, and is currently under review by the FDA.  Phase II results with an anti-B cell antibody, ofatumumab, demonstrated a marked effect on number of B cells and a 90% decrease in disease activity on MRI.  Another anti-B cell antibody (ocrelizumab) is already in phase III testing, and I expect that these types of treatments will be very useful for MS in the future.  Dr. Voskuhl reported on her clinical trial of estriol in MS.  This study is based on the well documented clinical observation that MS relapses are less frequent in pregnancy, but increase in the 3 months after delivery.  There are multiple hormonal changes during pregnancy, and this study tested the idea that the hormone estriol might reduce MS relapses.  Subjects were about 180 women recently diagnosied with MS.  All were treated with glatiramer, and half received estriol.  The relapse rate in the group overall was low, but it was lower in the subjects on estriol.  This treatment looks interesting, but it needs further study to definitely demonstrate the benefit.  There was one report of a preliminary study of stem cells given into the spinal fluid.  There are a number of studies of stem cells for MS either completed or in progress, but almost all of them give the stem cells intravenously.  In this study, they took bone marrow, grew the cells in culture to obtain stem cells, and then injected them into the spinal fluid via lumbar puncture.  They treated only 6 subjects, but didn’t note any severe side effects.  We don’t know if either route of injection is effective, or which is more effective.  A Phase II multicenter study of stem cells given iv is now in progress. 

Scientific studies: 

There were several interesting reports outside of new treatments.  Vitamin D continues to be an active area of research.  An additional study relating low vitamin D levels to increased MS activity was reported.  This study used blood samples collected during a clinical study, so they had relapses and MRI scans carefully documented.  Another area of current interest is the role of B cells in MS.  One group demonstrated that B cells from MS patients secrete factors that are toxic to nerve cells, but B cells from controls do not.   A final interesting report was a study of gut bacteria in MS.  There are numerous different bacteria that normally live in the gut, and they have effects on the immune system.  This study reported differences in the bacteria found in MS patients and those in controls. 

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

copyright 2007-2018 John William Lindsey