MS Speaks

Multiple Sclerosis => MS - RESEARCH AND NEWS => Topic started by: agate on November 02, 2017, 04:05:33 pm

Title: (Abst.) Progressive MS: Whom to treat, with what, and for how long?
Post by: agate on November 02, 2017, 04:05:33 pm
Presented at the ECTRIMS/ACTRIMS conference in Paris, October 25, 2017:

#66 - Progressive MS: whom to treat, with what and for how long?

B.A.C. Cree1, F. Paul2

1University of California San Francisco, San Francisco, CA, United States, 2NeuroCure Clinical Research Center, Charité Universitätsmedizin, Berlin, Germany

The most vexing therapeutic challenge in multiple sclerosis is progression in neurological disability that occurs independently from relapses. Progressive MS can occur from clinical onset (primary progressive) or following a history of relapses (secondary progressive). Progressive MS can be further classified in association with or without disease activity, i.e. in the setting of ongoing clinical relapses or radiographic evidence of disease activity as determined by MRI.

Until recently, clinical trials of immunomodulatory therapies known to be effective in relapsing MS yielded disappointing results in trials of either primary progressive and secondary progressive MS. However, recently several clinical trials targeting progressive MS showed benefit.

Ocrelizumab, a B-cell depleting anti-CD20 monoclonal antibody, is the first medication proved to slow disability progression in a subgroup of patients with primary progressive MS and has received regulatory approval for treatment of primary progressive MS in some countries.

Siponimod, a next generation selective S1P1/S1P5 sphingosine receptor modulator, was shown in a large registration trial to slow accumulation of disability in patients with secondary progressive MS and is under regulatory review.

MD1003 (high dose biotin) was shown to improve disability in some patients with either primary or secondary progressive MS in a multicenter randomized controlled trial and is under further investigation in an ongoing multinational study. MD1003 is also available in some countries on a named patient basis.

Given the success of these studies, neurologists for the first time will now have to understand therapeutic selection in progressive forms of multiple sclerosis. This case based course will review the most up-to-date understanding of how progressive forms of MS can be treated. Data from these recent successful clinical trials that provides insights into therapeutic selection based on patient characteristics will be reviewed, and informative case vignettes will be presented. In addition to disease modifying therapies, use of symptomatic treatments will be highlighted. Lastly, clinically important unanswered questions and directions for future research will be outlined.

Disclosure: Prof. Bruce Cree Md, PhD, MAS has received personal compensation for consulting from Abbvie, Biogen, EMD Serono, Novartis and Sanofi Genzyme.
Prof. Friedemann Paul, MD has received personal compensation for consulting or speaking from Alexion, Biogen, Chugai, MedImmune, Merck Serono, Novartis, Sanofi Genzyme and Shire.