AAN2018: Laquinimod joins the PPMS graveyard

I am just back from LaLa Land and the AAN2018 meeting. I am feeling exhausted, MSed-out, conferenced-out and very concerned about the future of neurology (more on this on my Medium post). 

The AAN2018 was far too long, too spread-out (the venue was cavernous with rooms that were in general too large) and too expensive (conference fees, LA hotels, restaurants, regional wines and flights). The AAN is definitely not the premier MS meeting it used to be. ECTRIMS and ACTRIMS have usurped the AAN to such a degree that there was very little new MS data presented at this meeting. My presentation on the Arpeggio results was at least novel. As promised I have uploaded it onto SlideShare for you to browse. 

In short, the Arpeggio study was negative but does shows Laquinimod has an effect on brain volume in the first 6 months and that it has anti-inflammatory effects. I suspect this is due to laquinimod's effect on glial cells, i.e. it causes them to swell.

What the Arpeggio and other recent studies question is the use of short-term brain volume changes as a marker of neuroprotection in progressive MS. Short-term changes don't necessarily mean neuronal or axonal protection; Arpeggio shows that. Therefore I would be very careful to draw any conclusions about brain volume changes without other biomarker and clinical changes going in the right direction to infer neuroprotection.

The AAN2018 will be remembered as the NFL meeting; i.e. the time when neurofilament light chain became accepted as the MS soluble biomarker of choice. Numerous presentations from clinical trial datasets have established NFL as a predictive, prognostic and treatment outcome biomarker in RRMS and possibly progressive MS. It is clear that NFL levels track most closely with inflammatory MS activity, i.e. relapses and focal MRI activity. The role of NFL as a biomarker in non-relapsing progressive MS is less certain. We will have to wait for additional data to be analysed and presented to assess its utility in progressive MS.

NFL is our equivalent to the CRP in rheumatology. 


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