Associate Professor Mark Slee, neurologist at Flinders Medical Centre and Vice-Chair of MS Research Australia’s Research Management Council, has provided this report on the first day of workshops and meetings that precede the formal ECTRIMS program.
Workshop Day – Associate Professor Mark Slee reports on ECTRIMS
The meeting, whilst not officially opening until tomorrow morning, was in full swing today with half a day of educational courses and in the afternoon, a series of scientific and seminar sessions.
The Charcot Foundation seminar focussed on the development of monoclonal antibody therapies in MS with a particular focus on therapies that target the B cells of the immune system. Big themes included the move toward monoclonal antibody synthesis that is less immunogenic to the patient (making it less likely to cause an immune response to the medication itself) but retaining high effectiveness, such as fully human monoclonal antibodies.
The data around B cell directed therapies was discussed in detail from rituximab through to ocrelizumab in relapsing and progressive MS. Other agents discussed were the upcoming medication, daclizumab, as well as the currently available, alemtuzumab and natalizumab.
Professor Richard Reynolds from London presented data on the possible role of B cell aggregates (clusters of B cells that persist around the outer membranes, the meninges, of the brain) and damage in the outer cortex of the brain. This is particularly a focus of attention for progressive MS, with some considering that the anti-B-cell therapies may be having their beneficial effects via reduction in meningeal B cell aggregation and associated cortical pathology.
The Charcot seminar was followed by a non-European perspective on MS services and challenges in MS care in countries outside of the ECTRIMS-ACTRIMS axis (Europe and North America). Themes here were the increasing prevalence in MS and neuromyelitis optica spectrum disorders (NMOSD) globally and the differing socio-political environments and the challenges they pose on access to evidence-based disease modifying therapies. Cultural perspectives on MS and its care were also discussed. Professor Bill Carroll, Western Australian neurologist and Chair of MS Research Australia’s International Research Review Board, spoke from an Australian and New Zealand perspective including significant discussion of the contribution that MS Research Australia has made to the MS landscape in Australia.
The final session of the day was a ‘Hot Topics’ session in which the pros and cons of induction therapy (an initial, brief, intense period of immunotherapy treatment followed by longer term maintenance treatment) versus escalation therapy (starting with ‘first-line’ medications and then moving to ‘second-line’ drugs if there is continued breakthrough disease activity) were debated. The outcome of the debate was that this question can’t be resolved currently – the key issue being that we do not currently have robust enough biomarkers (blood/CSF/imaging) to predict those patients who will experience aggressive disease and benefit from early aggressive therapies. Data on older immunosuppressants such as mitoxantrone right through to data on autologous haematopoietic stem cell transplant (AHSCT) and cladribine, and the long-term data from interferon-beta treatments were presented. It was agreed that for people with aggressive disease, an induction strategy could be justified but picking just who that is, is the difficult point. The audience vote favoured induction over escalation but the Chairs tempered the audience suggesting it is an issue not to be over-generalised and that a one-approach-fits all strategy is unlikely to be helpful.
We hope to bring you more news and highlights from ECTRIMS in the coming days.