1 S T CONGRESS OF THE EUROPEAN ACADEMY OF NEUROLOGY
Berlin, Germany, June 20 -23, 2015
Trends in MS research: New antigen-specific treatment approaches –
individualised therapy remains key goal
More than 500,000 people in Europe suffer from multiple sclerosis. New treatment approaches such as
antigen-specific immunisation strategies are among the topical MS research areas discussed at the Congress
of the European Academy of Neurology in Berlin. Experts urged for the development of truly individualised
therapy approaches in order to use available drugs in a more targeted way.
Berlin, 22 June 2015 – “This first EAN Congress is providing a major opportunity for the multiple-sclerosis
community to interchange research interests. We are witnessing a number of very good quality sessions and
presentations which reflect the amazing evolution in MS research and therapy,” Prof Xavier Montalban from
the Vall d’Hebron Hospital in Barcelona, President of the European Committee for Treatment and Research in
Multiple Sclerosis (ECTRIMS), said at the 1 st Congress of the European Academy (EAN) in Berlin. “Among the
important developments in our dynamic field are the constant expansion of therapeutic options, focus on the
potential of individually tailored therapies and new approaches towards antigen-specific immunisation.”
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterised by a high
degree of heterogeneity. Around 500,000 people in Europe suffer from this degenerative, progressive
autoimmune disease, with two to three times as many women affected as men. It is most often diagnosed in
people aged 20 to 40. In young adults, along with epilepsy, MS is one of the most frequent neurological
diseases, and a major cause for disability in this age group. The overall cost of MS to European health and
social-care systems is estimated to be 15 billion euros a year.
Decoding the mechanisms of MS pathogenesis
Among the issues that are of particular interest to MS experts around the globe is a better understanding of
the pathogenesis of the disease, which is currently still incomplete. “Deciphering the underlying
pathomechanisms, elucidating the precise mechanisms of tissue damage in relapsing-remitting MS and
establishing the relative role of these processes in irreversible tissue damage in progressive MS are key aims of
ongoing MS research,” according to Prof Montalban. This might open the path to identifying new treatment
targets that can help halt disease progression or even to developing regenerative treatment approaches.
Personalised treatment one of the “most unmet-needs areas”
“Nowadays the number of treatments available for MS with different mechanisms of action is quite impressive.
There is a well-founded reason to say that we will be able to help people suffering from MS ever more
effectively and more quickly,” Prof Montalban commented. A broad range of new results on classic injectable
drugs, new oral substances and monoclonal antibodies as well as future treatments, including neuroprotective
and remyelinating agents, are being discussed at the EAN Congress.
The broadened range of therapies available generates questions as to the positioning of each substance and
the development of additional algorithms, but might also facilitate a truly individualised therapy approach, Prof
Montalban explained: “Personalised medicine is one of the most unmet-needs areas we have in MS nowadays.
To understand the prognosis of a specific patient, to choose the best possible treatment for that patient and to
predict the effects and side-effects that a specific drug might have in this individual are not easy exercises. But
there is growing evidence, including data on biomarkers, which supports us in this task.”
A promising new approach to immunisation
“The role of antigen-specific tolerance and the possibility that antigen-specific therapy may eradicate
unwanted adaptive pathologic antibody and T cell-mediated immune responses that damage tissue while
preserving the normal immune function responding to infectious agents and retaining the ability to fight
malignancy are among the innovative and exciting approaches in MS therapy that are being discussed at the
EAN Congress,” Prof Montalban reported. “We do not yet have very convincing evidence in MS that would
prove a dominant immune response to a specific antigen or group of antigens. However, a more specific
antigen-driven disease such as neuromyelitis looks like quite a promising model for this concept of therapy.”
1
1 S T CONGRESS OF THE EUROPEAN ACADEMY OF NEUROLOGY
Berlin, Germany, June 20 -23, 2015
The presentation of data from the ETIMS trial at the EAN Congress was a subject of interest. “In brief, coupling
autologous blood cells chemically with seven myelin peptides to induce antigen-specific tolerance was tested in
an open-label, single-centre, phase-I trial,” Prof Montalban explained. “The feasibility, tolerability and safety of
this novel therapeutic approach were established. A multicentre proof-of-concept phase-IIa trial is in
preparation.”
Another approach in this field might be the use of patches to administer specific myelin peptides in order to
influence immune response in MS patients, Prof Montalban reported. “A very impressive trial conducted by a
research group form Lodz, Poland shows the immunoregulatory potential of transdermal immunisation with
myelin peptides in MS patients. In a double-blind phase-1 trial in 30 patients with RRMS a significant reduction
in MRI and clinically measured disease activity was observed, opening a new window for different ways of drug
administration, again based on the concept of immune tolerance”, Prof. Montalban explained.
Neuroprotective potential of vitamins and antiepileptic drugs
A high-dose vitamin and a substance so far used for its antiepileptic properties might both have potential as
novel treatments in MS, as shown by two trials presented at the Berlin Congress. “One study using biotin in
progressive MS and another using phenytoin in optic neuritis both show signs of having neuroprotective effects
that warrant further studies,” stated Prof Montalban, commenting on the preliminary findings .
Understanding risks and benefits
Another focus of particular importance, according to Prof Montalban: “Effectiveness in real life and also data
coming from extension studies of a number of drugs are being presented and discussed. This clinical and
imaging information is essential in understanding the benefit/risk ratio of any drug.” Among the myriad results
in this field, a late-breaking result on magnetic resonance imaging outcome for patients who switched from
interferon beta-1a to alemtuzumab has been presented at the EAN Congress. It shows that the switch
improved MRI outcomes in patients who received more than two years of prior disease-modifying therapy.
Data on the long-term history of untreated MS are very scarce, although of great interest to the research
community. At the EAN Congress, a Swedish research team has presented a 50-year follow-up study of an
incidence cohort of Gothenburg residents with onset of MS between 1950 and 1964, providing prognostic and
outcome data in untreated patients over several decades. “This very interesting paper indicates an increasingly
benign course of MS,” Prof Montalban said. “These data, very difficult to obtain, are really useful in our
decision-making processes.”
Sources: BrainFacts.org, Brain Disease in Europe, November 2013; EAN Abstracts: Steinmann, Antigen-induced tolerance: Highly selective
intervention in MS treatment; Barkof et al, Alemtuzumab Decreases New Lesion Formation and Slows the Rate of Brain Atrophy in
Relapsing-Remitting Multiple Sclerosis Patients Previously Treated With Subcutaneous Interferon Beta-1a; Martin, Antigen-specific
Tolerance in MS with Myelin Peptide Coupled Cells; Sellebjerg, MS Pathogenesis – where is it heading now?; Raftopoulos et al,
Neuroprotection with phenytoin in acute optic neuritis: Results of a phase II randomised controlled trial; Tourbah et al, Effect of MD 1003
(high doses of biotin) in progressive multiple sclerosis: results of a pivotal phase III randomized double blind placebo controlled study
EAN Press Office
B&K – Bettschart&Kofler Kommunikationsberatung
Dr Birgit Kofler
Phone: +43 1 3194378; +49 172 7949286; +43 676 6368930
E-mail: kofler@bkkommunikation.com
2