Last month, experts in multiple sclerosis (MS) research and treatment convened in New Orleans, LA for The Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2016 Forum. The three-day event, which was the first standalone meeting for the group, offered updates in emerging concepts in MS, pathogenic mechanisms, measuring disease progression, and more. The forum was organized around the theme, “Progressive MS: From Bench to Bedside and Back,” therefore many presenters dedicated their lectures to the latest developments and strategies for managing the challenges of progressive MS.
On the Emerging Concepts panel, in which junior faculty members presented the highest rated research abstracts, presenters highlighted new areas in research both in the understanding and treatment of MS. Speaking at the session, Nathaniel Lizak, MD noted that greater relapse rates during moderately advanced MS increase the probability of disability progression. He presented research suggesting that stronger immunomodulatory therapies mitigate the disability accrual in moderately advanced MS, disputing the notion of treatment cessation on the basis of disability milestone attainment. Another speaker on the panel, Pavan Bhargava, MD, pointed to a recent study suggesting that MRI can potentially detect foci of meningeal enhancement. Therefore, he recommended that continued studies examine the effect of drugs/biologics targeting the components of meningeal infiltrates.
Discussing the Acute effects of treadmill walking exercise on inhibitory control in MS, Brian Sandroff, MD noted that cognitive impairment is prevalent, disabling, and poorly managed MS. The results of Dr. Sandroff’s study suggested that a range of exercise intensities—from slower to faster—may offer benefit toward the inhibitory control of MS. Thus, patients don’t need to begin with vigorous exercise to achieve benefit; in fact, Dr. Sandroff suggested that “starting slow” could actually increase adherence. In addition to inhibitory control, Dr. Sandroff noted that preliminary evidence to suggest that aerobic exercise may benefit verbal memory and alertness in primary progressive MS.
In the broader scope of research, much work remains to understand the mechanisms of primary MS. Delivering the Kenneth P. Johnson Memorial lecture, Jerry Wolinsky, MD, explained that progressive MS could teach physicians about the broader underlying processes of all forms of MS. “If primary progress MS is just an outlier, then we don’t have to worry about it and we can treat it the same, especially if we capture it early,” said Dr. Wolinsky. “But if it’s telling us something about second process, it may perhaps offer the best ground to understand what that second process might be,” he explained.
In a session devoted to disrupting disease worsening in patients with MS, Aaron L. Boster, MD and Thomas P. Leist, MD, PhD discussed strategies for how physicians can harness the full potential of disease-modifying therapies. In cases of progression without apparent inflammatory activity, Dr. Boster said that there is an underlying need to understand the quality of data on which we make decisions. In terms of treating these difficult cases, Dr. Boster noted that we are entering a brave new world when it comes to opportunities to affect progression. However, despite that promise, none of these routes have proven to be reliable. “There are no easy answers,” Dr. Boster said. “We need to have a genuine conversation with patients that we might not be able to affect change, and if they are willing we can try these approaches knowing ahead of time that we might fail.” Dr. Leist also added that, when treating patients with any form of MS, physicians’ role in treating MS should extend beyond treatment and include counseling and a willingness to direct patients toward resources and appropriate avenues for living with MS.
Lively feedback followed many of the presentations, encompassing topics such as the need for sensitive outcome measures and the significance of negative trials.
Although progressive MS remains elusive in some respects, the snapshot of research and clinical insights presented and discussed at the meeting rendered both a brighter outlook for management of progress MS as well as a compelling portrait of a growing realm of research and therapeutic innovation.
To see Practical Neurology’s live coverage of the meeting as it unfolded, follow @PracticalNeuro in Twitter. #ACTRIMS2016