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Dr Claire Riley and Dr Rebecca Farber: Highlights from ECTRIMS 2016
Dr Claire Riley and Dr Rebecca Farber summarize, that Progressive Multiple Sclerosis (MS) is an area lacking in treatment options and was a major topic at ECTRIMS 2016. FDA and EMA were speaking about the pending ocrelizumab submissions, where early analysis of a clinical trial subgroup indicated positive results in progressive MS. Dr Farber and Dr Riley discuss this subgroup-analysis and the reasons behind the small effect.
Progressive disease is complicated, requiring multiple approaches. Exciting trials are underway, but there will be substantial challenges in enrolling patients particularly if ocrelizumab is approved. Dr Farber stated that it is possible that more add-on trials will be needed similar to trials on NMO (Neuromyelitis Optica).
In terms of symptomatic therapy, the session on deep-brain stimulation to address tremors was intriguing according to Dr Riley. For Dr Farber, the arbaclofen extended-release trial showed efficacy but without some of the CNS side effects of baclofen administration.
There were several informative sessions on clinical trial design for progressive MS and discussion on potentially alleviating the “Phase II trial bottleneck” in this patient population.
A new concept of NEAP (no evidence of progression) was discussed and Dr Farber is interested to see if this concept will be developed further.
The need for more biomarkers in general was an engaging topic, but is of particular importance in helping to better identify progressive MS. For example, there is no equivalent marker for gadolinium lesions in progressive MS.
Both Dr Farber and Dr Riley are interested to see guidelines on length of therapy, therapeutic lag, and efficacy endpoints if ocrelizumab is approved for progressive MS. They noted that these are also challenging questions with relapsing MS because clinicians don’t know if the patient would be having disease activity otherwise. In general, clinicians don’t know how long we should be keeping patients on therapy.
This meeting reinforced both Dr Riley and Dr Farber’s hopes that clinicians will be able to treat progressive MS by better identifying and characterising it. They stated that they are heading back to their clinics with positive news for their progressive MS patients.
Dr Claire Riley, Assistant Professor of Neurology, Neurological Institute, Columbia University NY, USA and Dr Rebecca Farber, Attending Neurologist Assistant Professor of Neurology, Neurological Institute, Columbia University NY, USA (editors)
This video was recorded at ECTRIMS 2016, September 14-17 2016, London, United Kingdom.