Results from trials in progressive MS, diet and lifestyle research, and myelin repair strategies took center stage during the American Academy of Neurology’s (AAN) annual meeting held in Washington, DC in late April. Nearly 13,000 neurologists and other researchers convened to share progress in understanding and treating neurological diseases like MS.
Read blogs from the AAN meeting
Explore scientific summaries (abstracts) on the AAN’s Website. Search specific words, authors or abstract numbers listed below.
Below are a few highlights of MS-related presentations focusing on stopping MS, restoring function, and ending MS forever. In most cases, studies presented are considered preliminary. Many will be analyzed more thoroughly, and likely published in peer-reviewed medical journals. Confidence in a study’s findings is reinforced when it is repeated by others, who attain similar results.
Stopping MS - Therapies
Many studies presented showed the continued benefit and safety of available therapies, as well as more evidence that early and ongoing treatment with a disease-modifying therapy has long-term benefits for controlling disease activity, delaying accumulation of disability and protecting quality of life.
When is it time to stop MS disease modifying medications? This question was asked by Ilya Kister, MD (New York University) and the international MSBase Registry team. Tracing 181 people who had stopped their MS medication after having no relapses or progression for at least 5 years, the team found that 24% developed relapses, 32% had disease progression, and 10.6% had both. Many (42%) restarted medication again, which was associated with a 59% reduced risk of progression. The authors noted that a larger and better controlled trial would be needed to answer the question of when to safely stop MS therapy. (Abstract P5.192)
Epilepsy pill protective? A trial funded in part by the MS Societies of the U.S. and the U.K., led by Raj Kapoor, MD (University College London) evaluated whether phenytoin, an oral epilepsy therapy, could protect against nerve damage in the retina (light sensitive layer of nerve tissue in the back of the eye). The trial involved 86 people with optic neuritis, an inflammation of the optic nerve and often the first symptom of MS. They received either phenytoin or a placebo for 3 months. On average those who received phenytoin had 30% less damage to the nerve fiber layer compared to those who received placebo. The results need confirmation in a larger study, but raise the possibility of “repurposing” a therapy already on the market with a long track record of successful use. (Abstract PL2.005)
Biotin for progressive MS: In a clinical trial in France, 154 people with primary- or secondary-progressive MS were given experimental MD1003 (concentrated biotin, a B vitamin), or placebo, for 48 weeks. The results suggested that 12.6% of those given MD1003 showed improvement in disability (using either the EDSS scale that measures disability progression, or improvement in a timed walk), versus none of those on placebo, and there were no serious safety issues reported. More research is needed to determine who might benefit from this approach. MedDay Pharma states that another trial is underway with results expected later this year. (Abstract PL2.002)
Dystel Prize winner: Professor Alastair Compston (University of Cambridge, UK) was chosen by a committee of his peers to receive the National MS Society/American Academy of Neurology’s 2015 John Dystel Prize for Multiple Sclerosis Research. He was honored with the Prize for driving advances in immunology from the laboratory to the clinic, and for his pivotal role in an international collaboration that revolutionized MS genetics research. Read details
Disappointing results in primary progressive MS: Fred Lublin, MD (Corinne Goldsmith Dickinson Center for MS at Mount Sinai Med. Ctr., New York) and colleagues conducted a 3-year study involving 970 people with primary progressive MS to test the ability of fingolimod (Gilenya®) to slow progression. The disappointing results suggested that this therapy did not slow MS progression. “We need a different strategy for treating primary progressive MS,” stated Dr. Lublin. (Emerging Science Abstract 006)
Why don’t immune therapies work in progressive MS? Mika Komori, MD, PhD (NIH) and team examined spinal fluid samples from 386 people with progressive and relapsing MS and people without MS to determine the numbers and characteristics of various immune cells. They observed indicators of inflammation in the spinal fluid of people with progressive MS, and that their immune cells were more likely to be embedded in the brain and spinal cord, whereas the cells in relapsing MS were circulating in the blood and lymph system. They suggest that treatments for progressive MS need to penetrate the central nervous system in order to work. (Abstract S12.001; recently published)
Restoring Function: Nervous System Repair
Can anti-LINGO repair myelin? Promising results were reported from a phase 2 clinical trial of the myelin repair strategy called anti-LINGO (Biogen). The study involved IV infusions or placebo every 4 weeks for 20 weeks to 82 people who had a first episode of optic neuritis. Optic neuritis involves inflammation of the nerve that connects to the eye, and it’s often a first signs of MS. After 24 weeks, those who had been given anti-LINGO had faster nerve signals along the optic nerve than before being given the therapy, compared to those on placebo. The speeding up of signals is thought to be an indication of myelin repair. The therapy seemed to be well tolerated except for some infusion reactions. Another phase 2 trial is ongoing in people with relapsing MS. (Abstract S56.008)
Stem cells to repair myelin? Previously, a small phase I clinical trial at Cleveland Clinic led by Jeffery Cohen, MD, tested the safety of taking individuals’ own adult mesenchymal stem cells from the blood, multiplying and then injecting them in the vein. The idea is to both inhibit immune mechanisms and to augment natural tissue repair processes. Preliminary results last year suggested that this approach was safe. To see whether these cells stimulated myelin repair, the team looked at specific brain lesions before and after the infusions of stem cells using advance imaging called DTI. Compared to before treatment, measures of axon loss stabilized, hinting that the cells may have stimulated repair and/or protected nerve tissue. A follow up clinical trial is now in planning stages. (Abstract P1.152)
Interim results from stem cell study: Researchers from the Tisch MS Research Center of New York presented early findings from their ongoing trial of mesenchymal stem cells. The study involves purifying and expanding neural progenitor cells from the bone marrow and then injecting them into the spinal fluid. They reported no safety issues after treating 7 participants with one dose and 2 participants with three doses. (Abstract P7.200)
Natural myelin repair measured with PET scans: Benedetta Bodini, MD (Hôpital Pitié-Salpêtrière, Paris) and international colleagues used a special method of positron emission tomography (PET) to trace the amount of myelin repair that occurred naturally in 20 people with MS and compared their results to standard measures of disease severity. They were able to define and measure changes in myelin repair and the amount of repair linked to individuals’ disease status. Further research may show PET to be a valuable way to track repair in clinical trials. (Abstract S29.008)
Restoring Function: Wellness, Lifestyle, Symptoms
Salt and kids: Some research suggests that salt may increase immune activity in the brain and spinal cord in MS. A team from the National MS Society-supported Network of Pediatric MS Centers showed that this may not be the case in children. Looking at salt intake prior to diagnosis among 174 children or adolescents with MS, compared with 337 people without the disease, they saw no increased risk of developing MS with excess sodium intake. More research is needed to understand if, when and how salt becomes a factor in MS. (Abstract S38.003)
Diet and fatigue: In a small study, Dr. Rocco Totaro, MD, and team (University of L’Aquila, Italy) tested whether a six-week diet (low in saturated animal fats and high in antioxidants) was associated with positive changes in body composition and fatigue in 17 people with relapsing-remitting MS. In their study, the percentage of body fat decreased, and fatigue lessened significantly. Larger studies are needed to determine how diet may impact MS symptoms and disease activity. (Abstract P2.211)
Balancing act: In a small study, 20 people with MS with mild to moderate disability used the Nintendo Wii Fit Plus to do balance exercises 5 times a week for 32 sessions. Francesco Patti, MD (University of Catania, Italy) and team reported improvement in several measures of balance and postural control. (Abstract P3.212)
Pain, fatigue, depression: Having MS along with other health conditions can influence disease course and symptoms. Ruth Ann Marrie, MD, PhD (University of Manitoba) and team tracked 949 people with MS in Canada. Nearly half developed pain over 2 years of study, and over one-third developed fatigue. Those with the worst pain also had comorbidities including COPD, anxiety or autoimmune thyroid disease. Depression was reported by 29%, and depression made fatigue worse over time. Understanding how other conditions make symptoms worse should lead to better ways to address them. (Abstract P1.114)
Obesity and MS progression – is there a link? Aliza Ben-Zacharia, DrNP (Mount Sinai, New York) examined the relationship between being substantially overweight (obese) and MS disease activity in 150 people with MS. They found the odds of having increased disability progression was 8 times greater in those who were obese versus those who were not. Having new brain MRI lesions was also more likely in those considered overweight or obese. This study does not prove that obesity causes progression, but it may offer additional health incentives to lose weight. Learn more about eating well. (Abstract P2.212)
Kids, behavior, and MS: Bianca Cersosimo and colleagues (State University of New York, Stony Brook) evaluated behavior problems in 145 kids with MS. They found behavior issues to be apparent in 68% of children, most often attention problems. Those with cognitive impairments reported higher rates of behavior problems in school. Managing these problems early can greatly benefit a child’s experience in school. The Society’s Network of Pediatric MS Centers of Excellence provides a handbook for parents and school professionals.(Abstract P4.025)
Marriage, MS and Gulf War vets. Jill Settle, MA (VA Medical Center, Washington, DC) and colleagues looked at 2,633 male veterans with MS to determine whether marital status would have anything to do with disease progression. Men who were never married needed to use a cane or wheelchair more quickly following symptom onset than those who were married at any point. This study does not show causation, but since marriage has been associated with quality of life improvements in other chronic diseases, it may show the importance of these improvements. (Abstract P5.199)
Is coffee protective against MS? Previous studies suggest that caffeine may protect against Alzheimer’s and Parkinson’s disease, but there haven’t been definitive studies in MS. An international team led by Ellen Mowry, MD (Johns Hopkins University) looked at coffee consumption in two large data sets – a group of 1,629 Swedish people with MS and 2,807 people without MS, and 584 people with MS and 581 people without MS enrolled in the Kaiser Permanente health plan of Northern California. In the Swedish study, drinking 6 cups of coffee a day was associated with a reduced risk of developing MS, and four cups a day did the same in the American study. Studies like this may help determine how to prevent MS in the future, but don’t speak to whether or how drinking coffee may impact MS in people who already have the disease. (Abstract S45.004)
Gut reaction: Research into impacts of gut bacteria presents the exciting possibility that probiotic strategies may ultimately be developed to treat MS.
A small pilot grant from the National MS Society helped launch the MS Microbiome Consortium of researchers in California, Colorado, and New York. Early findings from an analysis of blood and stool samples from people with MS treated with glatiramer acetate, untreated individuals, and people without MS showed differences in gut bacteria between those treated and untreated, and those with MS and without MS. The team has a new Collaborative MS Research Center Award from the Society to pursue this promising research. (Abstract P2.205)
Stephanie Tankou, MD, PhD (Brigham and Women’s Hospital, Boston) and colleagues looked for a link between gut bacteria and blood levels of vitamin D in 43 people with MS who had not yet begun treatment with a disease-modifying therapy. In this first analysis, they found that higher vitamin D levels were linked to increased amounts of a particular type of bacteria thought to have anti-inflammatory properties (ruminococcaceae). More analyses are under way that should help shed light on these findings. (Abstract P2.206)
Clue to why smoking makes MS worse? Smoking has been linked to higher risk of MS and to making MS more progressive. In a pilot research project funded by the National MS Society, Walter Royal III, MD (University of Maryland Medical Center, Baltimore) and team exposed mice to cigarette smoke. The smoke increased inflammation and oxidative stress compared to mice that were not exposed. While more work needs to be done, this could be an explanation for the increased risk of MS in smokers (Abstract P2.193)
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