The year is coming to an end. Also in 2019, there were many interesting news for MS patients, which I also partly commented on in this blog. In my opinion, nothing really groundbreaking has happened. With this, I don’t want to belittle the positive recommendation for Siponimod (Mayzent) for active secondary progressive MS, but as already explained (see DocBlog S1P modulators), it’s not really a new concept.
In 2019, we mainly gained further practical experience with the still relatively new B-cell depleting therapy with Ocrelizumab (Ocrevus) – the subgroup analyses of the approval studies also dominated this year’s congresses. I think it can be rightly claimed that we have a good alternative to Natalizumab (Tysabri) for JCV+ highly active MS patients with this antibody. On the other hand, the data communicated in 2019 on the extended dose interval of Natalizumab (EID – extended interval dosing) for JCV+ patients was encouraging, as this significantly reduced the PML incidence. This EID strategy will not solve the PML problem of Natalizumab from my point of view, but it will increase the medication safety for JCV+ patients who still want to be treated with Tysabri.
The temporary restriction of indication for Alemtuzumab (Lemtrada) has caused uncertainty. The European Medicines Agency initiated a safety review due to serious side effects, which has now been completed. Alemtuzumab should now no longer be used in patients with cardiovascular diseases, coagulation disorders or in MS patients with other autoimmune diseases, but is still available for the therapy of highly active MS.
This is ultimately good news, as the concept of pulsed immune reconstitution therapy (PIRT – Pulsed Immune Reconstitution Therapy) was also followed with great interest in 2019. Not only because Cladribin (Mavenclad) as an oral PIRT concept is increasingly being used, but also because the scientific interest in autologous stem cell transplantation – ultimately the maximum variant of immune reconstitution – has received a significant boost through new scientific publications in 2019.
I would like to claim that we are currently in a kind of transitional phase of MS therapy. We have already exploited the possibilities of anti-inflammatory therapies quite well, but we must also acknowledge that further progress in MS therapy is only possible if effective strategies against the neurodegenerative component of MS are found. In addition, we suspect that digitization will lead to profound changes in our approaches in the future – we still don’t have clear ideas of what these changes will look like exactly and what opportunities they will open up for the diagnosis and therapy of MS – but there is no doubt that these changes will come.
Accordingly, I am not worried that it will become boring in the future. The topics for MS-DocBlog will certainly not run out. Therefore, I am already looking forward to the next year with you and the news and changes that we will look at and comment on together. Now all that remains is for me to wish my esteemed readers a merry and blessed Christmas season. Enjoy the Christmas holidays with your loved ones and get through the New Year well.
Your Mathias Mäurer
