ECTRIMS Meeting

The European Committee for Treatment and Research in MS (ECTRIMS) which brings together the many of the world's leading MS experts, just finished meeting in Amsterdam. I was unable to attend the meeting this year, but have been following the results from a distance as much as possible. From what I can tell, my job is going to be a lot harder in a few years. The management of MS is about to become much more complicated, though in a good way. 

At the meeting the results of five major drug trials were announced, and four of them showed positive findings. These include trials of two oral medications known as BG-12 and Teriflunomide.  Additionally, results from trials of two antibodies (like Tysabri) were reported. These are daclizumab, a medication that is given once per month subcutaneously, and alemtuzumab, which is given as an intravenously for five days in one year, followed by another three day course of the medication one year later. One of the oral medications, known as Laquinimod, failed to do better than placebo in a large clinical trial, a significant financial setback for Teva, the company that makes Copaxone.

So, what does this mean for MS patients today? First of all, these drugs have to be approved by the FDA. This process can take many months, and there is no guarantee of approval. In 2010, two oral medications were expected to be approved by the FDA. Gilyena obviously did receive approval, but another medication, Cladribine, was rejected as there was not enough safety data. The company decided to abandon the medication after this rejection.

Assuming that some, if not all of these medications are approved, it is unclear exactly what role they will play in the treatment of MS patients and how they will supplant or augment the existing medications. They all have different levels of efficacy in preventing relapses from MS and have different side effect and safety profiles. I will try to summarize the major pros and cons of these medications in the future. One natural question is which drug is the most effective at preventing relapses?  Unfortunately, unless these medications are compared directly to each other, this is a question that cannot be answered. So at present, no one can say if Gilenya is more powerful than BG-12, or if Tysabri is more powerful than daclizumab, for example. Additionally, no one knows if there is a role for combination therapy. Perhaps the interferons or Copaxone can be combined with these new medications to attack the disease from two different angles.

More research needs to be done with these medications and how they can be best used to optimally manage patients with MS.  Just as is the case now, there will be no “right” answer on how to use the medications, and doctors and patients will have to use their best judgment in chosing a treatment. However, it is an exciting time in terms of new treatments for MS —one that was barely imaginable only several years ago. Doctors and patiens will soon have many new weapons in their fight against MS. So, perhaps my job will actually be a lot easier.

I am available via e-mail at perspectivesinms@healthline.com and will try to answer all questions.