Personalized medicine the theme of Charcot meeting


REPORT FROM THE EUROPEAN CHARCOT FOUNDATION ANNUAL MEETING – BAVENO, ITALY, NOVEMBER 28-30, 2013 – The past 10 years have seen considerable progress in characterizing the etiopathology and clinical course of multiple sclerosis, and a variety of novel disease-modifying therapies are now available. Personalized medicine is the next step, fine-tuning treatment for individual patients and employing strategies with the appropriate risk-benefit profile.

Personalized medicine is the theme of this year’s European Charcot Foundation (ECF) meeting. At present, individualized treatment is determined by three interacting factors, according to Dr. Per Sorensen, Copenhagen, Denmark, in his opening lecture. These are the disease stage (CIS vs. RRMS vs. progressive MS) and severity; drug factors (efficacy, safety, convenience); and the patient’s assessment of the relative risks and benefits of treatment. Other factors, such as biomarkers and pharmacogenomics, are being investigated.

“We would like biomarkers of an individual patient’s prognosis,” Dr. Sorensen said. “We would also like to have biomarkers that could predict the response to drugs, preferably before we start therapy, so we are able to assess an individual’s likelihood of responding to a specific drug. This would make it possible to make a more rational choice of therapy.”

Prognosis is currently limited to clinical, radiological and demographic factors known to be associated with a more aggressive disease course. These factors include multifocal onset, motor or cerebellar involvement, high relapse frequency, a shorter period between relapses, early development of disability, and lesion burden on MRI.

Early treatment is recommended for all patients, Dr. Sorensen said, to minimize the inflammatory damage, cognitive changes and brain atrophy associated with the MS clinical course. For patients with mild disease, his general approach is to start treatment with an injectable therapy or teriflunomide. Patients with more aggressive disease at onset or with breakthrough disease during treatment with a first-line agent are treated either with fingolimod or natalizumab. The choice of fingolimod or natalizumab depends on JC virus antibody status, Dr. Sorensen said. In JCV Ab-positive patients, his preferred option is fingolimod, with alemtuzumab emerging as a possible treatment for selected patients with highly active disease.

The risk-benefit assessment is best performed after the patient has been on treatment for a year, he concluded, since the individual patient’s response and tolerability while on a given medication will be better known.

Reviewer: Dr. Daniel Selchen. Head of Neurology, St. Michael’s Hospital, Toronto, Canada.

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