One focus of this years meeting was progressive MS. There were a number of talks on
the mechanism of damage in progressive MS, and some talks on treatment. There is currently no treatment
which has a marked benefit in progressive MS, and there is increasing interest in finding new treatments for this type of
MS along with better ways to measure changes in progressive MS. A study done in the UK with three drugs
already approved for other uses; fluoxetine, amiloride, and riluzole; had negative results.
focus was risk management for current treatments. Two useful and reassuring presentations reported on death
rate and cancer risk with some of the highly effective MS treatments that I currently use. There was no
significant increase in the death rate with rituximab, and there was no signal for an increase in any type of cancer, and
in particular no increase in risk of breast cancer with rituximab. The current label for ocrelizumab raises
the question of increased risk of breast cancer, but it seems unlikely that is a real cause and effect relation since it was
not seen in the much larger rituximab group. Rituximab and ocrelizumab are very similar, and I expect they
should have the same risks.
Unlike previous years, there were very few clinical
trial results and very few completely new approaches to treatment. The main exception is the study of the
tyrosine kinase inhibitor evobrutinib. This drug inhibits a protein found in B cells and macrophages that
is important for regulation of immune responses. In the phase II study, it had encouraging results on MRI
activity and possibly clinical relapses over 24 weeks. The phase III study is currently beginning, and
this will be an interesting drug to watch.
My major research interest is the
role of Epstein-Barr virus in MS, and there were a few presentations on this topic. Dr. Olsson reported
that a protein called anoctamin-2 cross-reacts with the EBV nuclear antigen, and that a significant fraction of MS patients
have an antibody against anoctamin. Increased antibodies against anoctamin predict risk of MS in the future.
Dr. Klemens reported that in a large cohort of new MS patients from Germany, all persons were infected with EBV.
This supports the idea that infection with EBV is required to get MS. One poster reported that MS
patients with more active disease were more likely to have a high level of antibodies against EBV, and another reported that
many of the cytotoxic T cells in MS brain are specific for EBV.