A new term in MS research that has emerged in recent years is PIRA, or progression independent of relapse activity. It purports to quantify the proportion of disability worsening due to non-inflammatory neurodegenerative processes. However, the new metric has its shortcomings and the methodology used to quantify PIRA has varied since the concept first appeared in 2017. Read More
Neurology
MULTIPLE SCLEROSIS – THE YEAR IN REVIEW
November 12, 2019InTORduction
B (as in billion) cells
Novel therapies, new chapters
SDMT revisited
The year 2019 saw important changes in how multiple sclerosis is being managed in an a increasingly complex therapeutic landscape (reviewed in Cree et al. Curr Opin Neurol 2019;32:365-377). The tectonics of that landscape are also shifting as new drugs are approved, generic formulations become available and the hothouse regulatory environment cools. Read More
PML reported in patient newly-treated with ocrelizumab
October 30, 2019A case of progressive multifocal leukoencephalopathy (PML) has been reported in a previously untreated MS patient who received ocrelizumab. The case was first reported on a blog posted by Dr. Gavin Giovannoni, Barts and The London School of Medicine and Dentistry. Details of the case were confirmed in an email from Roche to NeuroSens. Read More
New developments in secondary-progressive MS – ECTRIMS 2019
October 10, 2019SPECIAL REPORT
Recent positive trials in primary- and secondary-progressive MS (ORATORIO, EXPAND) have fuelled interest in the etiology, pathophysiology and treatment of progressive MS (reviewed in Secondary-progressive MS: conceptual and practical challenges, NeuroSens, April 17, 2019; and Progressive MS trials – design and interpretation, NeuroSens, September 4, 2019). In Part 3 of this series, we summarize some emerging concepts in PMS and new trial data in SPMS. Read More
Report on higher-efficacy therapies in MS – ECTRIMS 2019
October 2, 2019SPECIAL REPORT
Recent studies and physician surveys have reported an increasing use of higher-efficacy disease-modifying therapies in the treatment of MS. An analysis of the NeuroTransData MS registry in Germany found that in the periods 2010-2012 and 2016-2017, DMT use increased from 68.4% to 76.8% (Bergmann et al. ECTRIMS 2019; abstract P1063). Treatment was initiated about 3-4 months earlier from first MS symptom (mean 224 to 108 days) with a higher proportion now starting therapy within six months of diagnosis (83% to 92%). However, there was also greater volatility in DMT use – the mean time to discontinuing a DMT decreased from 19.9 months to 6.1 months, primarily due to adverse effects (16%) or lack of efficacy (13.9%). Switching is now primarily to an oral DMT (65.2%) or a MAb (46.6%) rather than to an injectable (16.4%). Annualized relapse rates (ARR) have declined over the past decade (from 0.23 to 0.16) but are similar for injectables (0.16), orals (0.16) and MAbs (0.12). For the most recent cohort, the mean time from first MS symptom to EDSS >3.5 is now 18.8 years, with only a low number of patients (1.6%) converting to SPMS. Read More