ECTRIMS 2019: the best of Australian research in MS

Multiple sclerosis

By Michael Woodhead

12 Sep 2019

Australians were out in force at this years ECTRIMS meeting in Stockholm where the latest developments in MS research were presented to a huge international audience.

One of the recurring themes at the meeting was the apparent reduction in rates of disability of MS and improved prognosis seen in recent years. Whether this has been due to changes in diagnosis, disease prevalence and improvements in treatment was the subject of many presentations.

One study presented by researchers from Spain showed that based on data from 1,139 patients followed for nine years, the mean time to diagnosis decreased from 2.9 years in patients with a CIS in 1994-2000 to 0.9  in 2010-2016. Over the same period the mean time to DMT initiation decreased from 4.8 years to 0.79 years.

The ECTRIMS conference included a presentation of findings on the impact of disease-modifying therapies (DMTs) on disability progression in relapsing (RR) MS, co-authored by Professor Helmut Butzkueven of the Department of Neuroscience, Monash University. Based on real world data from a cohort of 15,602 patients with RRMS from MS databases in Sweden and Italy, the study showed that continuous DMT exposure for more than 10 years reduced the risk of confirmed disability progression (CDP). Specifically, the study showed a protective effect of DMT on reaching 12 and 24-month CDP (Hazard Ratios of 0.90 and 0.65 respectively) compared to no treatment. Similarly there was a protective effect against reaching EDSS 4 and 6. The study also showed a clear gradient of treatment effect, according to different times to EDSS progression confirmation. The results were presented by Dr Giovanni Lucisano of the University of Bari in Italy, and the study was sponsored by Biogen.

ECTRIMS also heard that several factors that modify the effect of MS immunotherapy have been identified in a study led by Royal Melbourne Hospital neurologist Dr Tomas Kalincik. Younger age, shorter disease course, mild disability and a previous stability on treatment were factors that affected immunotherapy effects on relapses and disability outcomes, according to data from 14,717 patients. The effect of treatment declined with age (-1% per year), disability (-14% per EDSS step), the number of prior therapies (-24% per therapy) secondary progressive MS (-68%), recent disability worsening (-20%), and recent on-treatment relapses (-55% per relapse), especially severe relapses (-66%), the study found.

And aggressive MS can be predicted early by three factors: older age at symptom onset, greater disability during the first year and pyramidal signs in the first year, according to research led by Dr Charles Malpas (PhD) of the Clinical Outcomes Research Unit (CORe), Royal Melbourne Hospital. In a study of 2,403 patients, 145 (6%) were classified as having aggressive MS. Bayesian Model Averaging (BMA) identified three predictors: age >35 at symptom onset, EDSS > 2.5 in the first year, and the presence of pyramidal signs in the first year. The overall model significantly predicted aggressive MS (AUC = 0.82) and presence of all three signs was strongly predictive, with 32% of such patients meeting aggressive disease criteria. Conversely, absence of all three signs was associated with a 1.4% risk.

On the clinical assessment of MS, the ECTRIMS conference saw novel findings presented by Dr Gustavo Noffs and colleagues at the University of Melbourne showing that assessment based on cognitively demanding speech tasks may be better predictors of functional and structural cerebellar dysfunction than the current assessments based on motor performance. In a study involving 65 people with MS they showed that cerebellar function and volume were better gauged through tasks with concomitant motor and language-cognitive demands. These included speech sampling with tasks such as reading a paragraph out loud and telling an interesting personal story. Scores from these tests correlated better with cerebellar white volume than others such as SARA (ataxia) scores, they showed. “Incorporation of free speech sampling into cerebellar assessment protocols may improve monitoring of functional and structural decline of the cerebellum,” they concluded.

A poster presentation by Australian researchers showed that MS treatments may increase the risk of abnormal cervical screening tests, based on a preliminary study carried out at two tertiary MS clinics in Melbourne. Dr Anneke van der Walt and colleagues at Monash University analysed data from 102 women with MS who had been receiving disease modifying treatments. Among the 19 women who had an abnormal cervical screening test after MS onset, the rate of abnormal tests was 20.6 cases/1,000 person-years overall during  nine years follow up. However the rate of abnormal tests was lower while on BRACE therapies compared to after starting high-efficacy therapy (12.6 vs 38.6/1,000 person years exposure) they found.

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