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Epstein-Barr virus:
Dr. Aloisi gave a presentation on the accummulation of B cells (the type of lymphocyte that makes antibodies) in the brains
of people with MS. In some cases of MS, B cells accummulate both just outside the brain and around the blood vessels
in the brain. People with these accummulations tend to have loss of myelin surrounding the B cells. She presented
data showing that most of these B cells are infected with Epstein-Barr virus. This virus has been linked to MS by other
studies, and these findings were very interesting to me since I am actively investigating the relation between EBV
and MS.
Daclizumab:
This is a monoclonal antibody which blocks the receptor for interleukin-2 and interferes with the function of lymphocytes.
It has shown some promise in uncontrolled studies treating small numbers of people with active MS. This is the first
placebo-controlled study. It included 230 patients, who were divided into placebo, low dose, and high dose groups and
followed for 24 weeks. All patients were also taking interferon at the same time. Patients in the high dose group
had a 72% reduction in disease activity on MRI scan. This drug looks like it is worth studying further.
Bone Marrow Transplant: This is a very aggressive treatment for
MS. Essentially the aim is to wipe out the existing immune system, and replace it with a new immune system
derived from bone marrow stem cells. The benefit of the treatment is that relapses and enhancing lesions on MRI are
essentially eliminated. However, brain atrophy on MRI continues, and some patients progress in disability. There
are multiple possible complications, and the mortality rate is decreasing but still around 2%.
Alemtuzumab: Dr. Compston from Cambridge gave the Charcot lecture at the end of the conference
on Sunday. He reviewed the development of alemtuzumab (previously known as Campath), a monoclonal antibody that depletes lymphocytes.
This drug has proven very effective in preventing relapses in MS, but it can also cause autoimmune thyroid disease and
autoimmune platelet loss. Like bone marrow transplant, the results seem to be better in patients with relapsing
remitting MS treated rather early in their course. Secondary progressive patients tended to continue to progress.
He spent some time considering the question of whether MS has both inflammatory and degenerative components, a topic
also discussed extensively by Dr. Confavreux in his lecture. The eventual place of this antibody in MS treatment
is not clear. It is starting the last phase of clinical testing now.
REGARD
study--Rebif vs. Copaxone: This is a large clinical study comparing the effectiveness of Rebif,
an interferon, with Copaxone, glatiramer acetate. The trial was funded by EMD Serono, the makers of Rebif. There
were 386 people on Rebif and 378 on Copaxone followed for 96 weeks. The main outcome measure was the time to first relapse.
They did not find any difference between the two treatments, but the number of relapses observed was less than they expected.
The number of patients who completed the study was similar in both groups. The take-home message from this study is that
either interferon or glatiramer is a good choice of treatment for relapsing-remitting MS, and there is no reason to prefer
one over the other based on effectiveness or side effects.
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