ECTRIMS 2014: Daclizumab results

Daclizumab was my number 1 ECTRIMS highlight: what is it telling us about MS? #MSBlog #MSResearch

"My number one ECTRIMS highlight is the MRI daclizumab results, which shows that daclizumab reduces brain atrophy compared to Avonex in both year 1 and year 2. Why? This is telling us that daclizumab is having an effect on end-organ damage in MS and supports its positioning as a highly-effective therapy in MS. Big deal you may say? The reason why this is so interesting is  that daclizumab challenges most of the immunological dogmas about MS. Here is a drug that is not overtly immunosuppressive and has little impact on the effector function of B cells, CD4+ and CD8+ T cells. Please note these cells are meant to be key players in MS. Daclizumab also reduces T-regulatory or T-reg cell numbers and function; aren't T regs cells also meant to be a major players in MS?"

"What daclizumab does is it expands a population of cells called CD56-bright NK cells. These so called natural killer cells are part of the so called innate immune system and play a role in anti-viral responses. Daclizumab is therefore the one DMT with a mode of action  that seriously challenges the autoimmune MS dogma and possibly supports an alternative view of MS. We simply can't ignore Daclizumab's putative mode of action; it is telling us something very important about MS."

'The great tragedy of science - the slaying of a beautiful hypothesis by an ugly fact.' Thomas Huxley

Arnold et al. Brain MRI results of DECIDE: a randomized, double-blind trial of DAC HYP vs. IFN β-1a in RRMS patients. ECTRIMS 2014.

1. DAC HYP substantially reduced the burden of T2 hyperintense, Gd+,  and T1 hypointense lesions (black holes) compared to IFN beta-1a.
2. Improvements in MRI parameters could be seen as early as Week 24  and were sustained over 96 weeks.
3. DAC HYP reduced brain atrophy compared to IFN beta-1a over 2 years of treatment.

CoI: multiple