Taking a pulse in multiple sclerosis: Patient-centricity real-world data and new therapies at ECTRIMS 2016

ECTRIMS 2016 was a record-breaking year with the number of abstracts and delegates at an all-time high. This undoubtedly brought an air of enthusiasm that was kick started with the British Imperial Military Band welcoming all congress attendees to London. The energy was carried on throughout the four days demonstrating the exciting times ahead for multiple sclerosis (MS) with real world data supporting the efficacy of existing treatments along with high hopes of new therapies. All of this movement in the MS field highlights the cutting-edge work being conducted to ensure patients with MS get the best possible outcomes from their care.

Exploring real-world MS burden and DMT effectiveness

Patients and clinicians now have a wider choice of therapy than ever before. Understanding the comparative effectiveness of these therapies, and whether the clinical trial data can be replicated in routine clinical practice, is therefore critical for providing patients with an optimal, individualised treatment pathway.

This is an area of interest that has seen a large amount of growth over the past few years, reflected in the numerous presentations at ECTRIMS 2016 that focused on the longer-term use of therapies in a real-world setting.

Data from patient records derived from registries across Europe, including Italy, Spain, Sweden and Denmark, and from reimbursement claims data supported the long-term use of disease modifying therapies (DMTs) improving outcomes such as relapse rates and disease progression in MS patients. Kalincik and colleagues, for example, explored the comparative efficacy of alemtuzumab, natalizumab, fingolimod and interferon β using data from MSBase. Data confirmed the results from pivotal clinical trials and demonstrated the similar efficacy of natalizumab and alemtuzumab on relapse rates, with natalizumab providing the greatest reduction in disability.

Exploring the burden of MS, Biogen presented data from a Europe-wide cost of illness study in over 16,000 patients. The study highlighted the substantial impact of fatigue and cognitive impairment on quality of life at all disease severity levels, and that an inability to work and need for social and family support contribute to the cost of MS.

Putting the patient first

Patient preference is becoming more of an influential factor in treatment decisions especially in MS. With resources on the internet and social media being more available, patients are more than ever being involved in the management plan of their disease.

Patient empowerment was a key highlight of ECTRIMS, with a session entitled ‘Patient empowering and coping’ focusing on the coping strategies for patients with MS. Using both an evidence-based and shared decision-making referral models, the session focused on:

• Strategies to improve patient knowledge and facilitate informed treatment choices
• Scientific evidence on patient symptoms self-management, such as depression and fatigue
• Integrated care approaches tailored to the requirements of patients with advanced MS

Potent induction therapy: a new MS treatment paradigm?

The use of potent induction therapy for patients with MS is often an emotive discussion and took pride of place in one of the ‘Hot Topic’ sessions of the conference.

Edan and colleagues argued that initial treatment of early active relapsing remitting MS should be with a potent induction therapy, rather than standard immunomodulation then escalation. They cited evidence that mitoxantrone followed by maintenance treatment affords better disease control than monotherapy with an interferon beta, that natalizumab provides effective early disease control and that a 5-day course alemtuzumab provides long-term clinical benefits in patients with early relapsing MS.

As with all discussions, there are two sides to every story and one that Emmanuelle Waubant was keen to tell. By contrast, Waubant and colleagues argued that these newer treatment strategies for MS alter or suppress the immune response in a more dramatic way than escalation therapy and may be associated with a higher risk of opportunistic infections.

Limited long-term data on the potential benefits and risks of potent induction therapy are currently available, but the emergence of future data should support the development of optimal treatment sequencing strategies for patients with MS.

It’s clear that both sides have clear evidence and reasoning behind their arguments but what side are you on?

And finally, new therapeutic options for patients with MS

With more players entering the market, the treatment landscape in MS is continually evolving.

ECTRIMS gave Roche an opportunity to present data from three phase 3 trials of ocrelizumab in patients with relapsing-remitting multiple sclerosis (RRMS) [OPERA I and OPERA II] and primary progressive multiple sclerosis (PPMS) [ORATORIO] compared with placebo and interferon β-1a. In PPMS ocrelizumab showed consistent positive effects on walking and slowing disability progression, providing a new treatment hope for a patient group which currently have limited treatment options.

And Celgene also announced their intent in MS, hoping to enter the MS market alongside companies with a strong MS heritage and portfolio, such as Biogen, and pinning its hopes on its investigational therapy ozanimod. Celgene presented promising data from the extension of their phase 2 study and we await with interest the read-outs from their ongoing phase 3 trials.

Although this summary doesn’t include all the many topics explored and presented during ECTRIMS 2016, it highlights the ever growing volume of research going on in the MS therapy area. There are exciting times ahead for patients with MS as our level of understanding and knowledge continue to grow.

Harriet Dakin is an Associate Market Access Consultant at OPEN Access Consulting, a market access consulting and communications agency. For more information on how OPEN Access Consulting can help you achieve patient access for your life-changing therapies, please get in touch: HarrietDakin@openaccessconsulting.com