What will the new year bring? This question is not only of interest in terms of private and societal developments, but also with regard to the latest news in MS therapy research. In the past, MS experts have increasingly questioned the therapy escalation scheme established over years. Induction therapy is the keyword that is being discussed all around. For several years now, we have been successfully using cell-depleting antibodies such as Alemtuzumab. The long-term data of the substance, which was most recently presented at major conferences, show that the course of MS can be stabilized over many years with early use. Therefore, the proposal to use these highly effective therapies from the start (induction) and to de-escalate to weaker preparations over time is increasingly being heard. It is argued against this that the side effect profile of the cell-depleting therapies opposes such a general approach and therefore a start with moderately effective substances, which have a higher safety profile, is preferable. It is certain that this discussion will be continued intensively in 2017 and may result in a change in the therapy guidelines.
Crucial for this topic is the identification of patients with a high risk of a severe disease course. There would certainly be no objections to administering a highly effective therapy from the start in this group of patients, as the acceptance of side effects would be justified due to the severity of the disease. A blood test that distinguishes between highly active and moderate MS would be desirable, but no results have been seen so far. Currently, MRI is particularly helpful in classifying disease activity and it is expected that the MR criteria will be further sharpened in 2017, hopefully giving MRI more widespread trust and importance in therapy control.
A poor prognostic factor is the inadequate response to an immunotherapy – this has been proven by numerous clinical studies in recent years. It would therefore be desirable for this insight to be implemented in practice in the new year and for MS patients not to be left unnecessarily long on a suboptimally effective therapy.
Which therapy is the right one for an individual patient? This question is increasingly being asked, especially with the availability of new anti-inflammatory therapies. Here too, laboratory parameters would be desirable that indicate whether a patient benefits particularly well or particularly poorly from a certain active ingredient. This would simplify the choice of medication, but also save costs and time in the long term. Basic research offers some interesting approaches, but none of them have been able to assert themselves in practice so far. Hopefully, this will change in the new year.
The approval of Ocrelizumab, which is expected in 2017, will change the therapy landscape. It will be exciting to see how the availability of a highly effective drug with a favourable side effect profile, which also has an effect on progressive MS courses, affects prescribing behaviour.
Of course, it is to be hoped that impulses for neuroprotective therapies will also be observed in the new year. Unfortunately, the latest results on reparative approaches such as anti-Lingo were rather disappointing. Therefore, it will be exciting to see how therapy approaches with biotin or also ion channel blockades further develop in clinical testing.
Now that more and more renowned research groups have addressed the topic of the microbiome, it will also be exciting to see what new findings on certain dietary measures and intestinal flora will be communicated and published in 2017.
Thus, it can be assumed that 2017 will also be a dynamic and exciting year from the perspective of MS research and hopefully bring us a step closer to the goal of the most efficient disease control possible.
