Compared to previous
years, there were relatively few large clinical trials of new treatments reported. The only large phase III trial was
siponimod, an agent similar to fingolimod (Gilenya) which may have more selectivity and less side effects. They studied
patients with secondary progressive MS (SPMS), and the primary outcome measure was change in disability. They demonstrated
a 20% decrease in progression, and a robust effect on relapses and multiple MRI measures. Subgroup analyses suggested
that the treatment was more effective in younger patients with more inflammatory disease. This study is encouraging
because it is one of the few positive results in SPMS.
Another encouraging study was lipoic
acid in SPMS. This treatment is meant to be neuroprotective, and showed a benefit on the 25 foot timed walk and brain
atrophy as measured by MRI. Another potentially neuroprotective treatment, fluoxetine, had some positive effects but
less definite results.
There were also two studies on the effect of Vitamin D. For
the last several years, we have been measuring vitamin D in clinic, and putting patients on replacement treatment for low
vitamin D levels, based on studies showing that MS patients with low vitamin D had more relapses and MRI activity. But
we didn’t know if replacing vitamin D would help in MS. Two small trials were reported that added vitamin D to
rebif, and both showed a benefit on MRI. This isn’t definitive data, but it does support the continued use of
vitamin D replacement.
Another noteworthy report was a long term study of CIS patients which
found that treatment before the second clinical relapse delays time to early disability. This supports the benefit of
early treatment, which has been a clinical emphasis for the last several years.