Written on Monday 6th November 2017
Dorinda Hickey, CEO at OPEN Access Consulting (An OPEN Health company) has written a summary piece from the annual ECTRIMS meeting last week:
There appeared to be two sides to every story at the 2017 ECTRIMS meeting in Paris last week from the impact of multiple sclerosis (MS) on grey and white matter to whether MS is caused by T or B cells; the use of real world evidence versus randomised controlled trial data and disease monitoring using MRI assessment or clinical features.
The imminent arrival of so many new treatments heralds a new era in MS treatment where real world evidence (RWE) facilitates a personalised approach using predictive data, enhancing an already positive trend towards improved management of MS. “The future is in the past” we heard from RWE experts, who highlighted the wealth of evidence that can be used to predict responses and tailor treatments to MS phenotypes and patient demographics. Solutions were presented to manage uncertainties such as bias so that RWE is accepted as a valuable enhancement to RCT data. As well as the prediction of patient outcomes and facilitation of personalised medicine with optimal monitoring, RWE may be used to secure value based reimbursement, drive label changes and facilitate translational research in what is a highly active and data driven research environment.
Other interesting discussions ranged around the use of MRI to monitor disease progression, leading experts to conclude that “Clinical disease activity is only the tip of the iceberg”. The MS disease process involves a continuous impact on white matter in the brain with chronic white matter inflammation occurring across the disease continuum. Demyelination in the grey matter increases over time and becomes more prominent than white matter lesions in Secondary Progressive MS (SPMS). Regular MRI scanning means that this can be monitored and longer term outcomes predicted with greater certainty.
The change in the 2010 McDonald clinical criteria to reintroduce CSF oligoclonal bands was widely welcomed. This may mean that CIS patients who fulfil MRI criteria and are positive for oligoclonal bands receive a definitive diagnosis, news that was welcomed by clinicians and patient groups alike.
There was a lot of excitement over pharmaceutical grade Biotin with the SPI2 study being the only progressive MS study still actively recruiting, with positive results. The new S1P receptor modulators also showed promising results in RMS. Other news included a post hoc analysis of natalizumab data which demonstrates improvements in the timed 25 foot walk and 9 hole peg test, indicating the drug’s positive effects on peripheral functioning.
And finally, an interesting challenge from Professor Gavin Giovanonni on monitoring cognition. “If you can’t measure it you can’t improve it” he said, quoting Kelvin and emphasising that it was the duty of the MS specialist to monitor cognition. Cognitive impairment in newly diagnosed patients is a predictor of progression and a decrease in cognition leads to job losses and a decline in social capital which can have devastating consequences for patients’ quality of life. Cognitive rehabilitation works in head injury, so why shouldn’t it work in MS? For MS patients 50% of focal disease burden is in the grey matter and therefore not picked up on scanning. A variety of cognition tests are available online; BICAMS, SDMT and PST, enabling patients to self monitor. This enhances the patient interaction and allows physicians to identify improvements that would not otherwise be picked up.
All in all ECTRIMS 2017 offered some exciting developments in the management of MS and the prediction of longer term outcomes, with improvements in a variety of disease parameters expected in the years ahead.
For further details of OPEN Access Consulting, please get in touch via email with Dorinda Hickey, CEO, on firstname.lastname@example.org
To read more about the meeting visit https://www.ectrims-congress.e...