As a rule, I try to report on international congresses within the framework of DocBlog, which are particularly relevant for MS patients. Without a doubt, this includes the meeting of the American Academy of Neurology (AAN), which took place in Boston at the end of April this year. I myself had no opportunity to attend the congress this year and therefore also needed some time to review the results of the meeting. Overall, multiple sclerosis was well represented with two scientific lecture events every day and a multitude of posters, but completely new study results from groundbreaking phase II/III studies were not presented at this meeting. Essentially, further subgroup analyses of various already known studies were presented, which highlight different aspects of one or the other substance, although a certain redundancy could also be observed here. So, in a nutshell, there are currently no really groundbreaking insights to communicate.
Therefore, I have selected a few topics that I personally found quite interesting, but which only represent a very small excerpt from this huge international meeting:
(1) It can be stated that the progressive MS continues to be the focus of general interest. Here, for example, further details of the EXPAND study on the use of Siponimod in secondary chronic progressive MS were presented. The study was overall positive in terms of the primary endpoint of disability progression and also showed a corresponding effect on the MRI parameters. However, the difference in changes in the 25-foot walk test (Timed 25-Foot Walk) to baseline was not significant. Here, an advantage was only shown in patients with lower EDSS values when the active substance was administered. This result also suggests that the more therapeutic success you have in progressive courses, the earlier the intervention is started.
(2) In my view, a quite interesting work was communicated by the Cleveland Clinic in Ohio. The work dealt with the discontinuation of immunomodulatory therapy in patients over 60 years of age. I had already reported on the natural aging of the immune system with a decrease in inflammatory activity within the framework of DocBlog. The colleagues identified a total of 724 patients on immunomodulatory therapy over the age of 60 in their database. A total of 211 ended the therapy, only 9.5% of the patients started the therapy again, most often patient’s wish and not renewed disease activity were the reason for resuming the therapy. The results suggest that one can certainly consider ending therapy at an age over 60 without generating a great risk.
(3) An interesting topic – which has also been frequently discussed in DocBlog – is the discontinuation of Natalizumab. By evaluating the Tysabri observation program (TOP), the course after discontinuation of Natalizumab could be examined in over 1,000 patients. The most common reason for discontinuing the medication was concern about a PML disease. Basically, it was found that the EDSS value after discontinuation of the substance deteriorated on average compared to the pre-therapeutic phase. On the other hand, the EDSS value improved under Natalizumab therapy compared to the pre-therapeutic phase. The deterioration was most pronounced after switching to injectable therapies such as interferons and glatiramer acetate. The data thus confirm that discontinuation of Natalizumab is associated with the risk of overall deterioration and should therefore be well indicated.
(4) An important finding regarding the effect of Fampridine on the cognitive function of MS patients was communicated by an Italian working group. So far, the substance has mainly been used to treat walking disorders. However, due to its mechanism of action, it is conceivable that many more functional deficits in MS can be positively influenced. Thus, the result of an improvement in a cognitive test (SDMT) under Fampridine therapy is remarkable and could provide a basis for expanding the indication.
As I said, just a small, personally weighted excerpt… Many greetings to my esteemed readers.