ECTRIMS Highlights #ECTRIMS2015 #ClinicSpeak #BrainHealth #MSBlog #MSResearch
"Arrived back from ECTRIMS last night, tired and exhilarated. Tired because it was a busy week with little sleep. Exhilarated because of whole lot of new ideas and numerous leads to follow-up on. I would also like to thank the Barts-MS team; we had a very active ECTRIMS. Our social media presence speaks volumes for their efforts."
"This was a very good ECTRIMS in relation to data presented. My highlights in order of priority:
- Positive trial of minocycline in CIS trial; where to from here? As always how do we get minocycline licensed for MS? In my 'Hot topics' talk (see below) I highlight the need for legislation to allow repurposing of off-patent drugs. For minocycline this is clearly a high priority.
- Alemtuzumab 5-year brain atrophy rate; simply too good to believe. If correct these results suggest that alemtuzumab-treated MSers in long-term remission have brain atrophy rates in the normal range. There is simply no other drug that does this except for possibly HSCT in early MS (unpublished Canadian data). I am very keen to do a deep phenotyping study on this cohort of alemtuzumab-treated MSers to see how healthy their brains are and to see if there is any evidence of ongoing disease activity. It is important for MSers and neurologists to know this; it may the 'killer app' that alemtuzumab needs to get wide adoption and position it away from all other DMTs, except possible HSCT. The latter is another reason for us to do the ZEUS trial.
- Ocrelizumab in relapsing MS results; very good efficacy with a very favourable safety profile. Ocrelizumab will allow us to flip the pyramid and use highly effective treatments very early in the disease in the majority of MSers. However, my initial enthusiasm for ocrelizumab has been dampened by Steve Hauser's comments that a large number of their patients with relapsing MS who have been treated for 10+ years on rituximab have now developed SPMS. If this is correct then anti-CD20 B-cell depletion will not be a panacea. Clearly we need to do similar deep phenotyping studies in ocrelizumab-treated MSers and we need to see what happens to brain atrophy rates over the long-term.
- Ocrelizumab in PPMS results; although these were positive we will need to wait to see if the results are being driven by a subgroup of PPMSers with inflammatory activity. I would be surprised if the regulatory authorities license ocrelizumab with a wide indication for PPMS; I suspect they will push for a more restrictive license based on subgroup analyses. This study also suggests we need to focus our attention of the B-cell as being the main driver of MS disease activity.
- Cognition is an early predictor of disability progression in MS. This now supports the incorporation of cognitive testing into routine clinical practice and the counselling of MSers about cognition. A focus on cognition, which is almost certainly a driver of early disability in MS, may also help the speedup the adoption of the early effective treatment paradigm in MS. Who wants to lose brain and cognition? If MSers knew this they would push for more effective treatments earlier in the course of their disease.
- Brain Health; for me personally launching our 'Brain Health: time matters in multiple sclerosis' policy document was a a major achievement. We hope this document acts as the catalyst to a change in the way we view the management and treatment of MS across the world. Please download and read the document and if you agree with the policies pledge your support. The more people who support this document the more influence it will have and ultimately it will help us achieve our vision 'to create a better future for people with multiple sclerosis and their families'.
As promised the following is my 'hot topics' talk from Friday."
Labels: brain health, ClinicSpeak, ECTRIMS 2015