Neurologists and researchers from 115 countries gathered virtually for the American Academy of Neurology’s 2021 annual meeting. More than 260 MS-related presentations focused on many topics including ways to track and predict disease activity, emerging therapies, COVID-19, health disparities, and reversing symptoms.
Studies presented at meetings such as this are generally considered preliminary until they are published in peer-reviewed journals.
Below are select science highlights. Browse presentations here
, or follow links below to specific study summaries (scientific abstracts).
As part of the AAN meeting, Professor Vijay K. Kuchroo, DVM, PhD (Harvard Medical School) received the 2021 Dystel Prize for MS Research, focusing his prize lecture on the role of B cells in immune attacks on the brain in mouse models of MS. (Learn more about his research contributions
COVID-19 and MS
Researchers around the world continue to gather evidence to understand how COVID-19 impacts people with MS and other neurological conditions. Current evidence shows that simply having MS does not make you more likely to develop COVID-19 or more likely to become severely ill or die from the infection than the general population. However, some groups of people with MS are more susceptible to having a severe case of COVID-19. An ongoing global data sharing initiative is being led by the MS International Federation to combine results from around the world to better understand and offer advice for people with MS.
What happens after COVID-19?
Dr. Afagh Garjani (University of Nottingham) and others have been following outcomes of people with MS in the UK who had COVID-19 − either self-diagnosed or confirmed. Participants were already in their database, so the team was able to look at pre-COVID factors that may have played a role in how well they recovered. Nearly 600 responded to a questionnaire about their recovery. Of those, 77% recovered fully in 6 to 21 days. Those who had not fully recovered tended to have higher MS disability levels or showed signs of anxiety or depression prior to the pandemic. There was no link between any MS therapy and recovery from COVID. After recovery, about 57% experienced an MS relapse, and given this, Dr. Garjani cautioned that there appears to be no reason to alter a person’s MS treatment after COVID-19 infection. (View Abstract
Tracking activity during COVID-19 lockdown:
Leveraging an ongoing study that remotely tracks daily steps (measured with Fitbits) of participants with MS, Dr. Valerie Block (University of California San Francisco) and team looked at reductions of steps in 42 people during a shelter-in-place order in spring 2020. As expected, there was a marked decline in steps in the week and month after the lockdown began. After the order was lifted, some recovered their activities to near pre-lockdown levels. Those who did not tended to have lower activity before lockdown. This study also shows the value of wearable devices to augment rehabilitation and to encourage physical activity. (View Abstract
Addressing Symptoms and Comorbidities
Unusual weather and MS:
Dr. Holly Elser and colleagues (Stanford University) looked at insurance claims from 106,225 people with MS in a nationwide database, along with temperature reports from their respective counties. The results show that unusually warm weather was associated with increased visits to the emergency room, or inpatient admissions. The association was strongest in people aged 55-64. Further study should explore correlations with specific symptoms or disability. Learn how to ace temperature control
Virtual reality for pain:
In a study funded in part by a National MS Society pilot grant, Dr. Martin Malik and colleagues (New York University) tested the ability of virtual reality or VR to reduce pain. VR refers to the experience of wearing a headset that allows the user to view a video or interactive space in 360° that moves as the user moves. Users are distracted from their pain and also guided through techniques such as relaxation that can be used to control pain levels, continuing after the VR experience is over. In this small, early study of eight people with MS, acute and chronic pain were both reduced, and participants rated the intervention as highly acceptable and appealing. Get a handle on new approaches to pain
Vascular disease and MS:
There’s growing evidence that having MS and other conditions, or “comorbidities,” can make MS worse and reduce quality of life. People with vascular disease – such as high blood pressure, heart disease, or high cholesterol – tend to experience worse MS progression over time. To explore why, Dr. Vijayshree Yadav and colleagues (Oregon Health and Science University and VA MS Center of Excellence) analyzed high-powered MRI brain scans taken each year over 3 years in 29 people with MS who had vascular disease and 23 people with MS without vascular disease. They found decreases brain volume and in energy signals (ATP) in some brain areas in people with vascular disease, which may indicate weakening of the mitochondria, the tiny powerhouses within cells. Additional work is under way to understand these differences and how they may relate to vascular disease. (View Abstract
This year’s AAN reflected the growing awareness that neurological conditions, including MS, are experienced differently among people of different races, ethnicities, and socioeconomic factors, and several programs featured studies around this topic and also on ways to increase the diversity of the neurology workforce.
MS and race/ethnicity:
Dr. Victor Rivera (Baylor College of Medicine) and colleagues investigated differences in 722 people with MS who are enrolled (through their neurologists) in the North American Registry for Care and Research in Multiple Sclerosis (NARCRMS
). He reported that Black participants were more likely to be unemployed than white participants (8% vs. 3%) and to have more disability than whites. Only 57% of all participants were taking an MS disease-modifying therapy (DMT). Black participants were less likely to be taking a DMT than whites (39% vs. 64%), and Hispanic/Latinx participants were less likely to be taking a DMT than non-Hispanic/Latinx (43% vs. 62%). (View Abstract
New registry to improve care for Black people with MS:
Dr. Annette Okai (MS Treatment Center of Dallas) and collaborators launched the National African Americans with Multiple Sclerosis Registry (NAAMSR) in September 2020 to better understand MS and its management in this underserved population and to increase opportunities to be included in clinical trials. Interested individuals will be asked to complete questionnaires on the website (https://naamsr.org/
) at registration and annually, providing information on demographic and socioeconomic status, timing of symptom onset and diagnosis, MS pattern, use of disease modifying therapies (DMTs), quality of life, disability status, and access to care. (View Abstract
Different responses to B-cell therapy:
Lucia Saidenberg and team (New York University) reported that Black people taking IV-infused B-cell therapy (specifically, rituximab or Ocrevus) to treat MS or a related disorder, neuromyelitis optica spectrum disorder, tended to differ from whites in terms of how quickly their depleted immune B cells recovered. More research is needed to determine whether this means that Black people with MS may experience increased disease activity, such as a relapse or new MRI-detected brain lesions, before their next infusion is scheduled. (View Abstract
and Read more
Emerging Therapies for Stopping MS and Repairing Myelin
Many studies showed continued benefits of available therapies and longer-term safety information. Progress was reported in understanding how blood markers such as “neurofilament light
” may eventually be useful in predicting an individual’s future disease and how well they are responding to treatments. Other studies reported on potential benefits of experimental therapies including “BTK inhibitors” (such as fenebrutinib, evobrutinib, tolebrutinib), which are at different clinical trial stages in both progressive MS and relapsing MS. BTK inhibitors aim at both reducing the activation of immune B cells that play a role in MS, and inhibiting immune cells in the brain called microglia, which have been linked to MS progression.
Experimental B cell therapy:
Dr. Larry Steinman (Stanford University) presented on two phase 3 clinical trials of ublituximab, an experimental B-cell therapy similar to Ocrevus or Kesimpta, in 1094 people with relapsing MS. Ublituximab given by IV infusion every 6 months was compared to oral Aubagio in 1094 people with relapsing MS. Ublituximab significantly reduced relapse rates, MRI-detected new/enlarging brain lesions, and other evidence of disease activity. The most common adverse effects were infusion site reactions and lower white blood counts; serious events included infections. (View Abstract
- describes trial but not results)
Selectively stopping MS?
Dr. Robert Fox (Cleveland Clinic) and colleagues reported on a phase 2 trial of IMU-838 (vidofludimus calcium, Immunic, Inc.), similar to Aubagio, in 210 people with relapsing MS. IMU-838 acts on an enzyme called DHODH to reduce specific immune cell activity without negatively impacting some other immune cells. In this trial, MRI-detected new brain lesions were significantly reduced in groups taking IMU-838. Common adverse events included headache and nasal inflammation, and two serious adverse events were a fracture and kidney stones. A Phase 3 trial is in planning stages to determine the safety and effectiveness of this treatment in people with MS. (View Abstract
Early studies of compound to stop immune damage and repair myelin:
Laetitia Pouzol and colleagues (Idorsia Pharmaceuticals Ltd) reported on studies of ACT-1004-1239, a novel compound that acts on an immune messenger protein called CXCR7. In mouse models with MS-like disease, this compound both reduced the influx of immune cells into the brain and accelerated repair of myelin, the substance that insulates nerve fibers and is damaged in MS. ACT-1004-1239, taken orally, appeared safe and well tolerated in a small phase 1 study in 50 people who did not have MS. Further study is necessary to determine whether it will prove to be safe and effective for people with MS. (View Abstract