The following are selected presentations from the 12th Congress of the European Academy of Neurology, held June 27-30, 2026 in Geneva, Switzerland
Are annual MRIs necessary?
Effect of HE DMTs on PIRA
Impact of ofatumumab on brain atrophy
Frexalimab long-term results
Increasing prevalence of NMOSD in Finland
Are annual MRIs necessary?
The Amsterdam MS Cohort study retrospectively examined MRIs obtained during treatment with ocrelizumab to determine the extent of significant radiological activity in relapsing or progressive MS patients (Schoof et al. EAN 2026;EPO-0137). Significant MRI activity was defined as >1 Gd+ lesion or >3 new/enlarging T2 lesions. Overall, 1639 scans were obtained for 349 patients over a median treatment period of 49 months (about 1 scan/year per patient). Significant disease activity was detected in 27 scans (1.8% of scans) in 23 patients (6.8% of patients) over the four-year period. Routine annual MRIs in asymptomatic patients never led to treatment changes in practice. The authors concluded that the interval between MRIs can safety be extended in stable patients on anti-CD20 therapy, especially after year 2 of treatment.
Effect of HE DMTs on PIRA
A real-world study compared the rate of progression independent of relapse activity (PIRA) in 178 MS patients treated either with natalizumab or an anti-CD20 agent (Palazzo et al. EAN 2026;EPO-0367). The rate of first PIRA events was 37.1% for the natalizumab group and 32.6% for the anti-CD20 group over a minimum five-year follow-up. While the number of PIRA events was significantly higher with natalizumab, there was no difference in the cumulative risk (relative risk 1.15) of PIRA or time to first PIRA event between the two treatment groups.
Impact of ofatumumab on brain atrophy
An Italian study examined the impact of ofatumumab on brain atrophy and cognitive function in 85 MS patients (mean age 37.9 years) over a one-year treatment period (D’Amico et al. EAN 2026;EPO-0336). Ofatumumab was associated with a slowing in whole-brain atrophy (-0.15% to -0.09%), deep grey-matter atrophy (-1.01% to -0.36%), and thalamic atrophy (-0.94% to -0.77%) at one year. Treatment resulted in improvements in Symbol Digit Modalities Test (SDMT) scores (+3.79 points/year). Deep grey-matter atrophy was associated with cognitive worsening in patients with a baseline SDMT Z-score < -1.0; thalamic atrophy was associated with SDMT worsening in patients with an EDSS score >3.0.
Frexalimab long-term results
Frexalimab is a monoclonal antibody that targets the CD40-CD40L pathway involved in innate and adaptive immune activation. The 12-week phase II trial compared placebo with two doses of frexalimab: 1200 mg IV q4wk (1800 mg loading dose) and 300 mg SC q2wk (600 mg loading dose). At week 12, the dosing was changed to 1200 mg IV q4wk and 1800 mg SC q4wk for the open-label extension. The total number of Gd+ and new/enlarging T2 lesions remained low at 120 weeks, according to data presented last year (Vermersch et al. ECTRIMS 2025;O111). Updated results at 144 weeks were presented at EAN (Vermersch et al. EAN 2026;EPO-0785). The mean number of Gd+ lesions remained low in both treatment groups (IV 0.1, SC 0.0) at week 144. A total of 86% of patients were relapse-free. Treatment was well tolerated and lymphocyte counts were stable. Mean pNfL was reduced 45-47% from baseline to week 144 (Granziera et al. EAN 2026;EPO-0790). Brain volume loss from baseline to week 144 was -0.84% for whole brain, -1.18% for thalamus and -0.85% for cerebral cortex with the IV dose. Phase III studies are planned in RMS (FREXALT) and non-relapsing SPMS (FREVIVA).
Increasing prevalence of NMOSD in Finland
The prevalence of NMOSD has almost doubled in Finland over the past decade, according to new data from the national care registry (Aronen et al. EAN 2026;EPO-0675). Health records identified 128 patients with NMOSD. The national incidence was 0.13 per 100,000 patient-years for the period 2015-2023. The prevalence increased from 1.10/100,000 in 2014 to 2.05/100,000 in 2023. The standardized mortality ratio (SMR) for NMOSD was 2.36.