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Focus on Progressive MS, Dietary Approaches, and Emerging Therapies at the 2022 AAN Annual Meeting

April 12, 2022

Progressive MS, dietary approaches, and emerging therapies were among the important topics related to MS that were featured during the Annual Meeting of the American Academy of Neurology in Seattle in early April.  
   
Advances were reported from many different avenues of research, driving progress along Pathways to Cures that will stop MS, restore function, and end MS by prevention. Below are a few highlights from nearly 300 MS studies discussed, with links to their abstracts. Studies presented at scientific meetings are generally considered preliminary until they are published in peer-reviewed journals.


STOPPING MS
Many presenters shared results demonstrating continued benefits of available therapies, and longer-term safety data showing that early and ongoing treatment with a disease-modifying therapy has long-term benefits for controlling disease activity, delaying buildup of disabilities, and protecting quality of life. Several studies also reported on efforts to determine how to predict an individual’s disease course and progression to guide better treatment decisions.
 
Genes and progression: National MS Society-funded research Dr. Adil Harroud (University of California, San Francisco) described results building on work by the International MS Genetics Consortium, which previously identified over 200 gene variants that contribute to susceptibility to MS. The team did a new comprehensive study to locate genes that may relate to the progression of MS disability, and identified several genes of interest related to brain function that are unrelated to MS susceptibility genes. The team is pursuing this lead in hopes of finding ways to target these gene functions to find a way to stop MS progression. (Abstract S5.005)  
 
Dystel Prize: Xavier Montalban, MD, PhD (Vall dHebron University Hospital and the Multiple Sclerosis Center of Catalonia in Barcelona) described his team’s work toward understanding MS, improving its diagnosis, and finding better treatments as part of his 2022 John Dystel Prize for MS Research lecture. Read more about his team’s work
 
Lesions connected with nerve loss and progression: A class of experimental therapies called “BTK inhibitors” (such as fenebrutinib, evobrutinib, tolebrutinib) are in late-stage clinical trials in both progressive and relapsing MS. They are thought to both reduce the activation of immune B cells that play a role in MS, and also to regulate immune cells in the brain called microglia, which have been linked to MS progression. Now an international team reported MRI results from an earlier phase 2 clinical trial of oral evobrutinib suggesting that it may limit the growth of a type of brain lesion that slowly expands and is thought to indicate nerve loss linked to progressive disability. Phase 3 trials of this and other BTK inhibitors are now underway. (Abstract S14.009) The National MS Society has released a targeted research grant opportunity to further study the biological basis of slowly expanding lesions and other aspects of this type of inflammation in MS.


Keto diet shows benefits: Dr. J. Nicholas Brenton (University of Virginia) and colleagues assessed the safety and tolerability of the ketogenic diet – a low-carbohydrate diet that mimics fasting – in 65 people with relapsing MS. Most (83%) adhered to the diet over the 6-month study, and improvements were seen in body composition, fatigue, depression, quality of life, and neurologic disability. Lab tests showed reductions in molecules that promote inflammation and increases in molecules that inhibit inflammation. (Abstract S40.007) Learn more about diets and MS
 
Diet and disability: Dr. Ilana Katz Sand (Mt. Sinai) tested whether adherence to a Mediterranean diet (emphasizing plant-based foods like fruits and vegetables) could be linked with function and a measure of brain tissue volume. The results in 500 people with MS showed that sticking with this diet was linked to improvements in function, and the link was strongest in people with progressive MS. Results also suggest that changes in brain tissue volume underlie this link, suggesting that the diet may help protect nerve health. Tracking people on the diet for longer periods of time will be necessary to confirm these early findings. (Abstract S14.002) Learn more about diets and MS
 
Alternative Tysabri dosing:
  • Dr. John Foley (Rocky Mountain MS Clinic) and colleagues explored whether administering Tysabri® (natalizumab, Biogen) every six weeks would be as effective as the approved treatment course of every four weeks in nearly 400 people with relapsing MS. Studies indicate that treatment every six weeks yields less risk of developing PML (progressive multifocal leukoencephalopathy, a rare viral infection of the brain that often leads to death or severe disability). Treatment effectiveness was similar in these groups, as was safety. (Abstract S14.006)
  • Dr. Lana Ryerson and colleagues (NYU) showed that in participants in the Tysabri Touch® Prescribing Program, extending the dosing interval up to 12 weeks resulted in a reduced risk for PML. (Abstract P13.010)
  • In related news, a biosimilar to Tysabri was tested by Dr. Bernhard Hemmer and colleagues at Technical University of Munich. PB006 (Polpharma Biologics) showed comparable effectiveness and no cases of PML were reported in this study of 260 people with MS. (Abstract SBP6.003)
 
Health disparities related to neighborhoods and MS outcomes: Drs. Justin Abbatemarco, Deborah Miller, and colleagues (Cleveland Clinic) conducted a study seeking links between where an individual lives and their MS health. Using socioeconomic data on neighborhoods, they found in 1,000 people with MS that on average those in wealthier communities had fewer MS symptoms and less physical disability than those in neighborhoods considered to be disadvantaged. They concluded that socioeconomic status is a risk factor for worse disability, a finding that should inform advocacy efforts. (Abstract S40.002)
 
Bile acids and progression: Dr. Marianna Cortese (Harvard T.H. Chan School of Public Health) and colleagues traced links between bile acids and health in people with early MS who had been enrolled in a previous clinical trial. Bile acids are produced by the liver and can interact with immune cells and brain cells and influence their function. The team found that higher blood levels of bile acids were linked to lower progression of disability 5 years later, compared to those with lower levels of bile acids. (Abstract S5.004) Further research is underway, including a National MS Society-funded clinical trial of a bile acid supplement by researchers at Johns Hopkins University, which is expected to be completed later this year.
 
RESTORING FUNCTION
Preserving and repairing myelin is likely to be one of the best ways we can prevent nerve degeneration and allow the nervous system to restore connections and restore lost function. Several presentations focused on efforts to better detect nervous system repair, and creative new rehabilitation strategies and symptom management techniques to maximize abilities and to treat troubling symptoms and restore function.
 
Transcranial stimulation and walking improvement: Dr. Letizia Leocani and colleagues (University Vita-Salute San Raffaele) conducted a trial in which 100 people with progressive MS and walking impairment were randomly assigned to either a combination of repetitive transcranial magnetic stimulation and intensive rehabilitation or a sham procedure and rehabilitation alone. Repetitive transcranial magnetic stimulation involves placing an electromagnet against the forehead that targets nerve cells in the lower limb to stimulate them. Walking improved significantly more in the treatment group than the sham group. Two people reported transient headache and dizziness. Further studies are ongoing to explore the most effective treatment schedule and dose, and to determine how to identify the best candidates for this strategy. (Abstract S19.008)
 
Differing perceptions of cognition: Dr. Iris Katharina Penner (COGITO Center & Heinrich Heine University) and colleagues looked at forms filled out by 4,294 people with MS and their healthcare providers. The forms showed that, in the previous two weeks, 62% of people with MS reported cognitive problems, but only 27% of providers reported these issues in these same individuals. Addressing the reasons underlying such disparities may help to improve diagnosis and treatment of cognitive changes in MS. (Abstract P10.004)
 
Tracking cognition via smartphone games: There is a need for easier ways to detect cognitive problems in MS and treat them. Dr. Silvan Plass (University Hospital Basel) and team looked at the feasibility of using results from brain games played on smartphones to track thinking speed, flexibility, and other cognitive traits. After undergoing standard neuropsychological tests, participants were asked to play brain games twice a week for 5 weeks. The team found that analyzing the number of correct answers, response speeds, and difficulty levels reached reflected cognitive results from the standard neuropsychological tests. They also found some improvement after 5 weeks, and participants found it meaningful. Larger studies will help pinpoint the best game options to maximize benefits for people with MS. (Abstract S19.010)
 
Social networks in teens with MS: Dr. Micky Bacchus (The Children’s Hospital of Philadelphia) and colleagues compared the social networks of older teens with MS and those without MS. The teens with MS had smaller social networks, but more positive peer interactions and support. Teens without MS reported a higher proportion of their networks encouraging negative health behaviors (such as skipping class, not completing homework, using marijuana and alcohol, and eating junk food). The team is moving forward with research to determine if smaller networks are to be encouraged as a positive situation that can lead to better quality of life. (Abstract P18.002)
 
This and other progress shared during the American Academy of Neurology meeting offers hope that finding ways to stop MS, restore function, and end the disease forever are closer than ever before. Read more about Pathways to MS Cures

About Multiple Sclerosis

Multiple sclerosis is an unpredictable disease of the central nervous system. Currently there is no cure. Symptoms vary from person to person and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. An estimated 1 million people live with MS in the United States. Early diagnosis and treatment are critical to minimize disability. Significant progress is being made to achieve a world free of MS.

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