American Academy of Neurology - meeting round-up
04 May 2012
One of the biggest events of the neurology research calendar, the American Academy of Neurology (AAN) Annual Meeting, has just come to a close in New Orleans.
Out of 2,300 presentations, over 500 concerned MS. These covered all aspects from basic science through to investigations of licensed treatments. These presentations have not been peer-reviewed so should be considered as preliminary until published in a journal.
Here is a summary of some of the presentations:
Glatiramer acetate combined with beta interferon
A three year study investigating whether combined glatiramer acetate and beta interferon was more effective than either drug alone, found no clear difference in relapse rate or other measures between the groups.
Steroids for relapse - oral vs intravenous
Oral and intravenous methylprednisolone, taken after a relapse, were equally effective at improving disability scales (EDSS) and the number of MRI lesions. There was no difference in side effects.
Two groups of women with MS - premenopausal and menopausal - were studied over a two year period. Based on measures of disability and MRI scans, the menopause did not appear to affect the course of MS. Self reported symptoms worsened more in menopausal women than in a control group of similarly aged men, though researchers suggested this may be more to do with menopause than MS.
New treatments in development
The CONFIRM study looked at BG-12 taken as a tablet two or three times daily, and compared to Copaxone (glatiramer acetate) and placebo in 1,430 people. After two years, BG-12 reduced relapse rate by 44% or 51% and Copaxone by 29%. The number of people who were relapse free after two years (compared to placebo) was 45% or 34% for BG-12, 29% for Copaxone. BG-12 side effects included flushing and gastrointestinal upsets, such as diarrhoea, nausea and abdominal pain but these appeared to decrease after the first month of treatment.
Data from a phase III study, CARE-MS II were presented. 840 people who had previously relapsed while taking a disease modifying drug were treated with either alemtuzumab or Rebif (interferon beta 1a) for two years. For those taking alemtuzumab, relapse rate was reduced by 49% compared to Rebif. After two years 65% of alemtuzumab and 47% of Rebif were relapse-free. Thyroid side effects where observed in about 15% of the alemtuzumab group.
Phase II studies of ONO-4641 and siponimod (BAF312), with similar mechanism of action to fingolimod, causing lymphocytes to be retained in the lymph glands. ONO-4641 reduced MRI lesions by 77-92% compared to placebo, siponimod reduced MRI lesions by up to 80%. Side effects included slower heartbeat and blood pressure changes.
In laboratory studies, BIIB033 has been found to block the action of Lingo-1, a protein which inhibits remyelination. This phase I study assessed the safety and appropriate doses of BIIB033 in volunteers without MS and in people with relapsing remitting and secondary progressive MS. No serious side effects were reported and suitable dose levels were established. This drug is still at a very early stage of development and there is no guarantee that laboratory results will translate to a beneficial effect for people with MS, but this safety study paves the way for phase II investigations.