The annual European MS conference was held October 26-28, 2022 in Amsterdam. These are a few of the highlights that I found interesting, broken down into treatments and scientific presentations. There were not as many presentations on new treatments as in previous years, but there was a lot of interesting science.
In a phase II study, vidofludimus had a robust effect on MRI measures of disease activity. This agent has the same mechanism of action as teriflunomide (Aubagio), one of the currently approved treatments for MS. A very small study with 10 patients per group suggested that temelimab combined with rituximab might work in progressive MS. The outcomes used were MRI measures and biomarkers, so more work needs to be done to assess the clinical effect. This is encouraging, since we very much need more effective treatments for progressive MS.
One presentation compared the effect of autologous hematopoietic stem cell transplant (bone marrow transplant) to natalizumab (Tysabri). AHSCT basically wipes out the immune system with high dose chemotherapy, and then replaces with a new immune system regenerated from stem cells collected before the chemo. It is a very effective treatment with long lasting benefits, but has significant risk. The outcomes were similar to Tysabri, one of the standard and widely used treatments for MS.
And finally, Dr. Okuda from Dallas presented the results of a study of dimethyl fumarate (Tecfidera) in the very earliest stages of MS. These people had MRI findings that looked like MS, but had not yet had any clinical symptoms. It has been controversial whether these people should be started on treatment or not. There was a strong benefit for the treated group compared to placebo.
On the scientific side, I will focus on Epstein-Barr virus, which has been my personal research interest for years and which is having a turn in the spotlight. There were 3 presentations on antibodies in people before they developed MS which linked MS to EBV. Dr. Ascherio presented further results from his work on antibodies to EBV in people who later develop MS. They measured antibodies to many different proteins from many different viruses, and found increased antibodies only for EBV, mostly the EBNA-1 protein. Dr. Jons reported on a large cohort of 669 patients from Sweden with blood samples collected many years before onset of MS. Antibodies to EBNA-1 were increased 10 to 15 years before the clinical onset of MS, while blood markers of nerve cell damage increased about 5 years before onset. Dr. Sowa screened for antibodies to a broad range of proteins in 200 patients before diagnosis of MS, and found a motif which is present in 2 different EBV proteins.