The World Congress on Treatment and Research in Multiple Sclerosis (joint meeting of ECTRIMS, ACTRIMS, LACTRIMS): Montreal, Canada, 17-20 September 2008.
Article Type: Conference news
Subject: Multiple sclerosis (Care and treatment)
Multiple sclerosis (Conferences, meetings and seminars)
Neurology (Conferences, meetings and seminars)
Nervous system (Degeneration)
Nervous system (Conferences, meetings and seminars)
Central nervous system agents (Conferences, meetings and seminars)
Author: Clanet, M.
Pub Date: 03/01/2009
Publication: Name: The International MS Journal Publisher: PAREXEL MMS Europe Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 PAREXEL MMS Europe Ltd. ISSN: 1352-8963
Issue: Date: March, 2009 Source Volume: 16 Source Issue: 1
Product: Product Code: 2834200 Central Nervous System Prep NAICS Code: 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2834 Pharmaceutical preparations
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 217847857
Full Text: This congress was the first joint meeting for European, North and South American neurologists and neuroscientists to discuss 1 year of progress in treatment and research on multiple sclerosis (MS). More than 4500 delegates attended and with 83 oral presentations and 909 posters, it is difficult to select the highlights from this large amount of information. Probably the most interesting topic for neurologists and patients was new treatments.

Updates on a number of trials of new oral compounds were presented. The first Phase II trial of teriflunomid, a pyrimidine synthesis inhibitor, showed a significant reduction of active lesions on T2W magnetic resonance imaging (MRI). The recent 3-year extension study suggested sustained efficacy. The results from the Phase III study (TEMSO) will be available soon and other Phase III studies are in progress (TOWER, TOPIC). Three Phase III studies (TRANSFORMS, FREEDOM 1 and 2) of fingolimod, a sphingosine-1-phosphate-1P receptor ligand that traps lymphocytes in the lymph nodes, will be completed in late 2009. This drug is one of the more promising, if the results of the Phase II trial in relapsing-remitting MS (RRMS) are confirmed. However the safety profile must be carefully evaluated as some fatal viral infections have been reported. A Phase III trial in primary progressive MS (PPMS) (NFORMS) has been recently launched. CLARITY, a Phase III trial in RRMS of cladribine, a purine synthesis inhibitor is complete, and will be the first results in this series of oral treatments. Oral dimethylfumarate (BG-12) has immunomodulatory and neuroprotective effects by activation of NrF2 leading to antioxidant properties. A Phase II trial in RRMS has shown a significant reduction of the mean new T1 Gd-enhancing lesions and two Phase III trials are in progress (DEFINE, CONFIRM).

Other drugs, such as laquinimod, idubilast, statins, E2007 an AMPA antagonist, minocyclin and lamotrigin are being investigated and at least 10 monoclonal antibodies, targeting different immunomodulatory molecules, have been evaluated in MS patients. Among them, alemtuzumab, rituximab, daclizumab are promising. Alemtuzumab has shown a sustained effect in the 3-year extension study in RRMS patients, with an impressive 73% reduction in relapses and 71% reduction of disability compared with Rebif 44[R]. This monoclonal antibody will possibly be the next available therapeutic monoclonal antibody if an acceptable safety profile is confirmed in the two Phase III trials in progress (CAMMS 323, 324). The negative results of INFORMS, a Phase III study of rituximab in PPMS, again demonstrates the extreme difficulty of altering the degenerative process in progressive MS.

Three other interesting treatment approaches were presented: tovaxin, a T lymphocyte receptor vaccine, ATL 1102 (unfortunately gave negative results), an antisense oligonucleotide targeting VLA4 mRNA with promising positive results, and an aggressive treatment for patients with severe MS, consisting in intrathecal and intravenous mesenchymal stem cells injections with uncertain efficacy.

Finally among numerous presentations on the conventional immunomodulatory treatments, the PReCISe trial, confirmed the efficacy of glatiramer acetate in clinically isolated syndrome (CIS) patients, and in the Nordic trial monthly oral methyl prednisolone pulses was shown to reduce the relapse rate as add-on therapy in patients with active lesions on MRI, treated with subcutaneous beta interferon.

The congress gave the opportunity for delegates to listen to three main lectures. The ACTRIMS/CMSC Donald Paty memorial lecture was presented by Jock Murray (Nova Scotia, Canada) who gave an extensive overview of MS over the centuries, emphasizing through an inventive movie, the role of JM Charcot in framing the disease. Chris Polman (Amsterdam, the Netherlands), in the ECTRIMS lecture, presented the lessons from 20 years of MS treatments. Finally, Fernando Caceres (Buenos Aires, Argentina) in the LACTRIMS Leonor Gold Memorial Lecture outlined the important role of neurorehabilitation in a comprehensive approach for the care of MS patients.

A number of other topics were discussed including: the controversial role of inflammation and neurodegeneration in the earliest phases of the disease, the availability of new MRI techniques leading to a better correlation with the pathology of the disease, an update on the spectrum of Devic's disease, the fundamental aspects of myelin repair, the different presentations of paediatric MS, the problems of identifying new biomarkers predicting outcome and new epidemiological findings giving a renewed interest in vitamin D.

We need to acknowledge the different congress committees, not only for the excellence of the scientific programme and the perfect organization, but also for giving, for the first time, access to webcasts of the presentations including teaching courses, an initiative which allows each neurologist to extend his knowledge in this complex disease (http://www.msmontreal.org/).

M Clanet

Toulouse, France
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