Contributions
Abstract: 133
Type: Educational Session
Abstract Category: N/A
Introduction: Despite considerable progress in the treatment of relapsing-remitting MS there is still a tremendous need for an effective treatment of progressive forms of MS. Results from clinical trials during the last years indicate that immunosuppressive/-modulatory treatments have only a modest impact on disability progression during the progressive stages.
Aims: This presentation will summarize recent trial results in progressive MS.
Results: The S1P modulator siponimod has demonstrated a significant but modest reduction in disability progression along with an improvement in MRI parameters in secondary progressive MS. The monoclonal, B cell depleting anti-CD20 antibody ocrelizumab has shown comparable results in a phase III trial of primary progressive MS. These trial results indicate that the inflammatory component during later stages of MS has only a partial influence on disability progression. Another problem of treating progressive MS comes from the notion that the inflammation might be compartimentalized in the brain. Treatments that do not affect inflammatory cells within the brain including brain-resident microglia, infiltrated lymphocytes and macrophages will have no impact even on inflammation related disability progression. The negative results of the clinical trial with natalizumab in secondary progressive MS also point in this direction. Therefore there is a great interest in and demand for neuro-/myelin protective/regenerating therapies. Indeed clinical trials during recent years give a glimpse of hope. Neuroprotective strategies with sodium channel blockers like phenytoin and myelin regenerative/protective therapies like Biotin, anti-LINGO, and clemastine showed promising results in phase II trials. However, improvement in these trials was often limited to surrogate markers without a significant effect on clinical outcomes, with the exception of biotin that showed an improvement of clinical disability in a trial of progressive MS.
Conclusions: There is still an urgent need for more trials and new treatment approaches in progressive MS but it seems that we are at the beginning of a new era where anti-inflammatory treatments might be combined with neuro-/myelin protective/regenerating therapies to improve the disability and prognosis of patients with progressive MS.
Disclosure: Tobias Derfuss received speaker fees, research support, travel support, and/or served on Advisory Boards and/or steering committees of Novartis Pharma, Merck Serono, Biogen, Teva, Bayer-Schering, GeNeuro, Mitsubishi Pharma, MedDay, Roche, Genzyme.
Abstract: 133
Type: Educational Session
Abstract Category: N/A
Introduction: Despite considerable progress in the treatment of relapsing-remitting MS there is still a tremendous need for an effective treatment of progressive forms of MS. Results from clinical trials during the last years indicate that immunosuppressive/-modulatory treatments have only a modest impact on disability progression during the progressive stages.
Aims: This presentation will summarize recent trial results in progressive MS.
Results: The S1P modulator siponimod has demonstrated a significant but modest reduction in disability progression along with an improvement in MRI parameters in secondary progressive MS. The monoclonal, B cell depleting anti-CD20 antibody ocrelizumab has shown comparable results in a phase III trial of primary progressive MS. These trial results indicate that the inflammatory component during later stages of MS has only a partial influence on disability progression. Another problem of treating progressive MS comes from the notion that the inflammation might be compartimentalized in the brain. Treatments that do not affect inflammatory cells within the brain including brain-resident microglia, infiltrated lymphocytes and macrophages will have no impact even on inflammation related disability progression. The negative results of the clinical trial with natalizumab in secondary progressive MS also point in this direction. Therefore there is a great interest in and demand for neuro-/myelin protective/regenerating therapies. Indeed clinical trials during recent years give a glimpse of hope. Neuroprotective strategies with sodium channel blockers like phenytoin and myelin regenerative/protective therapies like Biotin, anti-LINGO, and clemastine showed promising results in phase II trials. However, improvement in these trials was often limited to surrogate markers without a significant effect on clinical outcomes, with the exception of biotin that showed an improvement of clinical disability in a trial of progressive MS.
Conclusions: There is still an urgent need for more trials and new treatment approaches in progressive MS but it seems that we are at the beginning of a new era where anti-inflammatory treatments might be combined with neuro-/myelin protective/regenerating therapies to improve the disability and prognosis of patients with progressive MS.
Disclosure: Tobias Derfuss received speaker fees, research support, travel support, and/or served on Advisory Boards and/or steering committees of Novartis Pharma, Merck Serono, Biogen, Teva, Bayer-Schering, GeNeuro, Mitsubishi Pharma, MedDay, Roche, Genzyme.