Each year, neurologists and MS researchers gather to discuss the latest research and developments in MS. ECTRIMS serves as the world’s largest professional organization dedicated to the understanding and treatment of Multiple Sclerosis. Its mission is to facilitate communication, create synergies, and promote and enhance research and learning among professionals for the ultimate benefit of people affected by MS. The ultimate goal of ECTRIMS is to improve basic and clinical research and clinical outcomes in MS.
Below are links to several of the poster presentations and brief summaries of the research that Rocky Mountain MS Center at University of Colorado physicians presented at this month’s conference. For the full posters, click on the titles below.
Time matters in multiple sclerosis – international consensus recommendations on diagnosis, management and access to treatment
Authors: Gavin Giovannoni, Timothy Vollmer, Helmut Butzkueven, Suhayl Dhib-Jalbut, Jeremy Hobart, Gisela Kobelt, George Pepper, Maria Pia Sormani, Anthony Traboulsee
Conclusions:
The overarching consensus recommendations of the international multidisciplinary working group are summarized below. They aim to facilitate a therapeutic strategy based on proactive monitoring, shared decision-making and improved access to treatment.
Minimize delays in the diagnosis of MS and in the time to treatment initiation.
Set goals for treatment and ongoing management that will optimize outcomes for every person with MS.
Consult the most robust evidence base possible, and generate further evidence as a basis for good decision-making.
Assessing the Efficacy, Tolerability and Safety of Rituximab for the Treatment of MS
Authors: Enrique Alvarez MD/PhD, Julie Seibert MD, Brandi Vollmer, Jace Blackburn, Molly Strobel, Julie Freean, Stefan H Sallau PhD, Justin Honce MD, Jeffery L Bennett MD/PhD, Augusto Miravalle MD, Teri Schreiner MD, John Corboy MD, Timothy Vollmer MD, Kavita Nair PhD
Objective: To assess the safety, tolerability and efficacy of rituximab in treatment in MS in a clinical setting.
Key Takeaways:
Findings suggest rituximab to be well tolerated and safe in the treatment of MS. It was extremely effective in preventing relapses and new MRI activity.
In patients transitioning off natalizumab, rituximab was effective in preventing rebound disease activity.
Predicting optimal response to B cell depletion with rituximab in MS using biomarkers: Utility of CXCL13 index
Authors: Enrique Alvarez MD/PhD, Laura Piccio, MD/PhD, Robert Mikesell, Kim Trinkaus PhD, Nhial Tutlam MPH, Michael Ramsbottom BS, Neville Rapp PhD, Samantha Lancia, MS, Becky Parks MD, Robert Naismith, MD, Anne Cross MD
Department of Neurology, Division of Neuroimmunology, Washington University School of Medicine in St Louis, MO; Department of Neurology, Division of Neuroimmunology, University of Colorado Denver, Aurora, CO; Division of Biostatistics, Washington University School of Medicine in St Louis, MO.
Objective: We sought predictors of optimal response to rituximab, a B cell depleting antibody, to help guide therapy selection.
Conclusion and Discussion:
- At baseline, optimal responders having NEDA had higher IgG indices (p=0.041), and higher CXCL13 indices ([CSF CXCL13/serum CXCL13]/albumin index; p=0.024), more contrast enhancing lesions (p=0.002) faster 25 foot timed walks (p=0.001), and Expanded Disability Status Scale (p=0.002).
- Rituximab treatment led to reduced CSF biomarkers of tissue destruction myelin basic protein (p=0.046), neurofilamentlight (p<0.001), and inflammation (CXCL13 index [p=0.042]).
- This study helps identify relapsing MS patients who will respond optimally to B cell depletion.
Improving bladder care for patients with multiple sclerosis
Authors: Miravalle, A; Smith, D; Vollmer, T; Corboy, J; Bennett, J; Schreiner, T; Alvarez, E; Berk, J; Michas-Martin, A; Cerdan-Trevino, M; Flynn, B; Stein, A; Valdez, B; Bhavani, P; Rocky Mountain MS Center at University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
Objectives:
To develop a systematic approach for the assessment, diagnosis, and care of MS patients with neurogenic bladder.
To review and understand the potential impact of early diagnosis and management of neurogenic bladder on quality of life in patient with MS.
Conclusions:
Preliminary data from the first round of evaluation suggest a high incidence of symptoms or impact on QOL from MS patients (75%).
Interestingly, this study was able to identify significant impact on QOL before patient’s PVR reached abnormal levels (49% of patients).
Further evaluation of outcomes will continue as patients complete urological follow up visits.
Does Long-Term Natalizumab (NTZ) Therapy Normalize Brain Atrophy Rates and Quality of Life (QOL) in Relapsing Remitting Multiple Sclerosis (RRMS)? A Longitudinal Study Using Whole Brain, Neocortical and Subcortical Atrophy Rates and Patient Reported Outcomes (PROs). Interim Analysis
Authors: Miravalle, A; Smith, D; Honce, J; Alvarez, E; Nair, KV; Sillau, S; Vollmer, B;; Corboy, J; and Vollmer, T; Rocky Mountain MS Center at University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
Objectives:
To use PRO’s in conjunction with various clinical and MRI measures to assess the impact of a change in brain atrophy rate on the patient’s daily functioning after long term natilizumab (Tysabri) therapy.
The present study is innovative and novel as it provides rate of brain atrophy in patients receiving Natalizumab therapy beyond 2 years, will compare brain atrophy rates with clinical, cognitive function and patient reported outcomes, and will provide means of comparison of brain atrophy rates among MS patient and normal controls.
Conclusions:
Our findings confirm previous associations between normalized brain volume, disability and cognition in patients who received Natalizumab therapy for over 2 years.
A longitudinal assessment of normalized brain volume changes over two years with comparison with healthy controls will follow.
Comparison of Fingolimod and Dimethyl Furmerate in the Treatment of MS: One Year Experience
Authors: Brandi Vollmer, Kavita V. Nair PhD, Stafan H Sillau PhD, Molly Strobel, Lorraina Robinson, John Corboy MD, Timothy Vollmer MD, Enrique Alvarez MD/PhD
Objective: To compare the first and second year experience of fingolimod (Gilenya) and dimethyl fumerate (Tecfidera) including discontinuation rates, efficacy and tolerability.
Conclusion & Discussion:
Patients on dimethyl fumerate have significantly greater odds of discontinuation at 1 year or less than patients on fingolimod.
This difference seems to be driven by discontinuation due to adverse events/tolerability issues.
Fewer patients on either dimethyl fumerate or fingolimod discontinued treatment during the first year due to disease activity.
Preliminary trends seen in 2 year discontinuation rates and causes of discontinuation are similar to what is observed in the 1 year experience.
Further analysis, including propensity matching, will be done to evaluate the 2 year experience.