Last week, the 32nd Congress of the European Committee of Research and Treatment in Multiple Sclerosis (ECTRIMS) took place in London. ECTRIMS is exclusively concerned with multiple sclerosis and related diseases, making it by far the most important European meeting on this disease – and thus the meeting at which the most important news and trends in the care of MS patients and research and drug development are exchanged annually. The number of participants is constantly increasing – this year there were more than 10,000 participants from many countries of the world on site, who discussed, networked and developed ideas for three days. I am pleased that I was able to be there – and would like to share a little of my congress visit with you in the next blogs. The congress opened on 15.09. with the ECTRIMS Lecture, which was given by the president of ECTRIMS Xavier Montalban from Barcelona. The topic of this lecture usually picks up on the current trends in MS care and this year dealt with personalised MS therapy. In contrast to various tumour diseases, MS does not have a marker that allows for the classification of patients and the identification of particularly at-risk patients (in terms of disease progression). Therefore, clinical care and monitoring remains of great importance. The basis is an early and accurate diagnosis, a careful prognosis assessment, the assessment of benefits and risks of therapy and finally the assessment of whether the patient responds to therapy in the further course.
As far as the prognosis assessment is concerned, MRI has a central role – the more MRI activity is visible, the more certain a long-term unfavourable course is. Also, the detection of spinal cord lesions in MRI is unfavourable and should therefore lead to consequent action, because – as Xavier Montalban emphasized again – what happens early in the course of the disease has an impact on a possible later disability. At the same time, it has been shown that the early use of drugs is associated with a more favourable long-term prognosis. In order for a patient to then receive optimal long-term therapy, the course under the respective therapy must be regularly checked, for which a score system from MRI findings and clinical monitoring has proven to be pragmatic, the so-called Rio score. Ultimately, this year’s ECTRIMS Lecture was a clear plea for early and consistent action.
I will report on new studies and scientific findings later. On the first day of the congress, I was mainly concerned with a pro and contra session in which it was discussed whether MS patients who are already in a wheelchair should still be included in clinical trials. The topic sounds quite provocative and an emotional discussion could certainly be expected. Pro arguments were that parameters beyond the ability to walk can be checked, such as hand function, which in many studies with further advanced MS patients showed a positive development when using the study medication. In addition, one could only treat the patients who have been examined in clinical studies, and one would thus exclude a certain group of patients.
Patricia Coyle (New York), who represented the counterposition, spoke out strongly against including MS patients who are completely dependent on a wheelchair (> EDSS 7). She specified that she is not against general inclusion in studies, but that she would definitely refrain from including severely affected patients in drug approval studies, because the changes in the EDSS at this stage are becoming increasingly difficult to prove and including too severely affected patients ultimately jeopardizes the success of potentially effective drugs with an effect on disease progression. So an argument that, contrary to first impressions, has nothing to do with discrimination, but is driven by concern for patients with progressive MS that unwise recruitment strategies lead to delays in drug development.
The ensuing lively discussion, however, showed that a significant problem lies in the use of the EDSS scale as the primary instrument for studies on progressive MS. I had already written something more detailed about this. The emotional discussion made it clear again that we need to develop new clinical measurement instruments to meet the needs of drug development.
