A round-up of research from MS Virtual 2020

ECTRIMS (European Committee for Treatment and Research In Multiple Sclerosis) is the largest annual MS research conference. Every three years the event is held jointly with ACTRIMS, the equivalent American organisation. This year's joint meeting was held online under the title MS Virtual 2020. The following is a small selection of information presented.

People who go on to develop MS will start using health services more frequently in the years before MS is recognised, according to Canadian research. Non specific symptoms and changes in health behaviour that happen before a definite diagnosis of a health condition can be made are called a prodrome. Information from medical records showed that people later diagnosed with MS were much more likely to have visited their family doctor, been prescribed medication or been in hospital in the five years before the first evidence of MS disease activity. Symptoms in this period included pain, headache, sleep disturbances and bladder problems, as well as mental health issues and skin complaints. Women who developed MS were less likely to have become pregnant than people in a non MS control group. This reflects data from other recent studies around the world, where increases in different symptoms were seen in people later diagnosed with MS.

It's not yet possible to identify who will develop MS from these symptoms, which are also common in the general population. However, the development of better markers for MS, particularly with measures of proteins in the blood, may mean that in the future the condition can be identified sooner.

People with MS with cardiovascular risk factors are more likely to show signs of loss of brain tissue (atrophy), according to an Italian study. Gradual loss of brain tissue happens throughout life, increasing as we get older. People with MS tend to lose tissue at a slightly higher rate than the non MS population. This study found that the rate was higher in people with MS with more than two cardiovascular risk factors, such as smoking, high blood pressure or high cholesterol. People with MS who smoked had a higher level of neurofilament light chain (NfL) in their blood, according to a separate Swedish study. NfL is a protein that can indicate MS disease activity and poor response to treatment. People who currently smoked tended to have the highest levels of NfL. Levels fell in people who had given up smoking depending on how long since they had stopped. It took about ten years after stopping for levels to be similar to those of people who had never smoked.

A study of the cancer drug bexarotene in Cambridge and Edinburgh showed that it led to the regrowth of myelin in people with relapsing remitting MS. However, the dose needed to produce this effect also led to serious side effects including thyroid disease and potentially damaging levels of blood fats. Although the fact that it is possible to encourage the regrowth of myelin in humans is a breakthrough and will lead to further research, the side effects mean that bexarotene will not become a treatment for MS. The Cambridge team are planning another remyelination study using metformin (a diabetes drug) in combination with clemastine  (a treatment for hay fever and allergies).

Effective first DMD better than escalation

People whose first treatment was a more powerful disease modifying drug did better than those who started with a less effective drug and then moved to something more powerful if it didn't control their MS (escalation), according to an Italian study. The researchers used the EDSS scale to measure changes in disability over an average of eight and a half years. People who started on a powerful drug showed a smaller and slower increase in EDSS scores.

DMDs and relapse during pregnancy

Women on more powerful disease modifying drugs were more likely to have a relapse during pregnancy than those on injectable or lower efficacy drugs, according to Australian research. This may reflect the fact that women on the more powerful drugs are likely to have more active MS. The researchers say that careful monitoring of these women may help to prevent relapse in pregnancy.

Covid and DMDs

More early studies of the impact of Covid-19 are starting to appear. Several studies reported that people with MS who contracted Covid-19, including those on a DMD, didn't have a more aggressive illness and their outcomes were similar to people who didn't have MS.

Treatments in the pipeline

Ofatumumab (Kesimpta)

People with relapsing remitting MS who took ofatumumab (Kesimpta) had fewer relapses, less inflammation on MRI scans and longer time to disability worsening than people taking Aubagio, according to research presented by the drug's manufacturer. Ofatumumab was approved by the FDA, the US drug regulator, in August. It is still being assessed by the European Medicines Agency. It will be marketed under the name Kesimpta.

Siponimod (Mayzent)

People with early, active secondary progressive MS who took siponimod (Mayzent) throughout a clinical trial had a lower risk of disability progression and fewer cognitive symptoms than people who had started in the placebo group and switched to siponimod later.

Masitinib

An oral drug showed "positive signs" in non-active progressive forms of multiple sclerosis according to a French study. Where drugs for progressive MS such as Ocrevus and Mayzent seem to be more effective in people still showing signs of inflammation, the masitinib trial focussed on people who didn't show inflammation on MRI scans. The study found measures of disability increased less quickly and the time to 'first progression' was longer than for people on a placebo.

• ECTRIMS (European Committee for Treatment and Research In Multiple Sclerosis)
• ACTRIMS (Americas Committee for Treatment and Research In Multiple Sclerosis)