Selected highlights from the European Academy of Neurology annual meeting, Budapest, Hungary, July 1-4, 2023.
Few patients achieve an optimal response with platform therapies
Fluid biomarkers predict early disease activity
When does PIRA start?
MOG antibodies uncommon
Clinical tip of the day
CONGRESS HIGHLIGHTS – MONDAY EDITION
Few patients achieve an optimal response with platform therapies
An analysis of MS patients in the Italian MS registry who started on platform therapies (n=7852) reported that only 26.9% had an optimal response to treatment (Addazio et al. EAN 2023;OPR-006). Over a 14.7-year follow-up, 28.5% experienced a confirmed disability event and 44.6% were switched to a higher-efficacy DMT. Responders to platform therapies had monofocal onset, a shorter disease duration and a lower EDSS score at baseline.
Fluid biomarkers predict early disease activity
Two fluid biomarkers, neurofilament-light chain (NfL) and kappa free light chain (kFLC), are useful individually and in combination to predict early disease activity, according to an analysis by the Vienna group (Hegen et al. EAN 2023;OPR-009). The study calculated the kFLC index (CSF kFLC/serum kFLC/albumin quotient) and the sNfL z-score adjusted for age and body-mass index for 86 patients with early MS. A total of 42% experienced a relapse during follow-up. The likelihood of being relapse-free was 90% if both the kFLC index and NfL z-score were low; 70% with low kFLC index and high sNfL z-score; 30% with high kFLC index and low sNfL z-score; and 2% if both were high.
When does PIRA start?
Patient age and relapses are the dominant drivers of progression independent of relapse activity (PIRA), according to an analysis of the Italian MS registry (n=3777) (Iaffaldano et al. EAN 2023;OPR-010). The overall incidence of confirmed 48-week PIRA was 22.3%. The cumulative incidence of PIRA was 1.3% by age 20.0 years; 9% by age 30.0 years; 21.6% by age 40 years; 39.1% by age 50 years; 60.8% by age 60 years; and 78.7% by age 70 years. PIRA events in pediatric-onset MS were rare during childhood.
MOG antibodies uncommon
A study of individuals with a first demyelinating event (n=641) found that only 2.7% of samples were positive for myelin oligodendrocyte glycoprotein (MOG) antibodies (Villacieros-Alvarez et al. EAN 2023;OPR-021). A total of 82.4% of MOG Ab+ patients presented with optic neuritis. Few MOG Ab+ patients were positive for oligoclonal bands compared to MOG Ab- patients (12.5% vs. 61.9%). Baseline MRI was normal in 62.5% vs. 26.0% of MOG Ab- patients. The absence of OBs (odds ratio 8.1) and optic neuritis at onset (OR 7.1) were independently associated with testing positive for MOG Abs. The researchers recommended testing for MOG Abs in OB-negative patients presenting with optic neuritis.
Clinical tip of the day
A Danish study of patients with MS or spinal-cord injury (n=114) found that cannabis was no more effective than placebo in relieving neuropathic pain (Hansen et al. EAN 2023;OPR-057). Cannabidiol (CBD) and tetrahydrocannabinol (THC) were tested alone and in combination versus placebo in a seven-week study. Pain was evaluated using a 7-item Numeric Rating Scale (0-10). The mean change from baseline in pain intensity was 1.4 with CBD, 1.4 with THC, 1.6 with CBD + THC, and 1.8 with placebo. No significant differences in pain reduction were observed between groups.