Which subgroups of progressive MS should be treated?
Dr. Xavier Montalban, professor at the University of Toronto, presented an overview of treatments in progressive multiple sclerosis (PMS), beginning the talk with why drugs in PMS fail. Firstly, the pathological processes involved in PMS compared to relapsing-remitting MS are different, therefore novel treatments to target the processes in PMS are needed. Second, the patient population that is recruited for the clinical trials are not appropriate to identify the benefits of treatment. Finally, the current outcomes used in clinical trials to determine effects of treatments are not sensitive measures. Based on the evidence collected from PMS clinical trials, there tends to be a better response in people with PMS with prior relapses, rapidly evolving disease, active baseline imaging, younger individuals, shorter disease duration, treatment naïve and lower disability score. For clinical trials in progressive MS to be effective, key questions needs to be answered:
In active PMS, is persistence of relapses or worsening of disease the definition of treatment failure?
In PMS that is not-active, is disability worsening or appearance of relapses the definition of treatment failure?
How long should treatments be administered to evaluate treatment efficacy?
What measures should define an effective treatment?
The Multiple Sclerosis Society of Canada announced last month a $5 million grant in support of the first, international, multicenter clinical trial to investigate cognitive rehabilitation and aerobic exercise in improving cognition in people with progressive multiple sclerosis. Want more information on this trial? Check out the blog or MS Update. The research team had the opportunity to catch up with quite a few of the members coordinating and researching this project as they gathered at #ECTRIMS2018 to discuss project details.
Overview of the growing list of potential risk factors for MS
Dr. Ali Manouchehrinia, Assistant Professor at the Karolinska Institutet, presented an overview of the risk factors for MS. Firstly, he discussed the genetic variants associated with increased risk for developing MS. To date, there are 233 variants identified that have been linked to MS. Geographical distribution of MS also hints toward the involvement of the environmental factors in increasing MS risk. Other factors that have also increased MS risk are Epstein-Barr Virus, smoking, increased BMI (particularly in individuals that have high BMI before the age of 20). Finally, Dr. Manouchehrinia concluded the talk by discussing the interaction between genetic and lifestyle factors. Both low vitamin D levels and high BMI and genetics increase the risk of MS. Overall, there is a growing list of environmental and lifestyle factors, and interaction between the two, associated with increased risk of MS.
Salt: Is there evidence to support it as a risk factor in MS?
The MS Society of Canada’s research team is preparing to fly over the Atlantic to the exciting city of Berlin, Germany to attend the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) from October 10-12, 2018.