#ECTRIMS2018 – Emerging MS Treatments, from Cannabinoids to Diet, Among Highlights at Conference

Thousands of scientists, doctors, pharmaceutical company executives and others — representing about 100 countries — will meet for three days to discuss and debate the latest developments in multiple sclerosis (MS) at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, best known as ECTRIMS.

This year’s congress takes place Oct. 10-12 in Berlin, Germany, and includes nearly 1,600 abstracts that will be the basis of oral and poster presentations spread over some 80 different meetings. They range from “hot topics” and “scientific” or “educational” platforms, to “satellite symposiums” and “plenary sessions.”

To help bring focus to this large and important  gathering, which Multiple Sclerosis News Today will cover onsite, we spoke with Bruce Bebo, PhD, executive vice president for research at the National Multiple Sclerosis Society (NMSS), about ECTRIMS and topics of particular interest to the society and the people it represents.

“This is always an exciting time of year,” Bebo said. It’s a chance to hear nearly “everything that is happening” in MS from experts “sharing the most recent work and most up-to-date results from their studies.”

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High on his list for 2018, as at last year’s ECTRIMS meeting in Paris, is research into treating progressive MS, a subtype that affects between 15 and 20 percent of all patients in its primary progressive form, and has only one approved disease-modifying treatment (Ocrevus, by Genentech). Another subtype, secondary progressive MS, is the natural disease course for those with the more common relapsing-remitting MS.

In a “late-breaking news” session on Friday afternoon, results from the MS SMART clinical trial (NCT01910259) in the U.K. will be released. This “super interesting trial,” Bebo said, is breaking norms by testing three different oral therapies — amiloride (a diuretic used in heart disease), fluoxetine (an anti-depressive, brand name Prozac, among others), and riluzole (a neuroprotective medication for patients with amyotrophic lateral sclerosis, or ALS, brand name Rilutek) — against a placebo in more than 400 people with secondary progressive MS (SPMS).

All these approved therapies have shown “promising signs in the treatment of MS,” and particularly SPMS, trial organizers state on its website. The NMSS helped to support this study, sponsored by University College London.

“I, of course, would be over-the-top excited if one or more of these medications showed effectiveness in progressive MS and could be developed into a new treatment,” Bebo said. “But even if not successful, it’s a really well-done study — it’s rich in new understandings of MS. We will learn from it, and it will inform the next trial in MS.”

Other highlights also are what might be called emerging science and treatments — the results of the “fundamental research … the investments made over decades” by the NMSS and similar groups, governments, and others, Bebo said. These monies, of which the National MS Society invests about $40 million each year spread over some 300 projects worldwide, have identified key “pathways that do a lot of damage in MS and have revealed targets for therapies.”

Emerging science of interest to Bebo at ECTRIMS 2018 include:

• A Phase 2 study (NCT02542787) in an oral cannabinoid derivative called VSN16R (by Canbex Therapeutics) that aims to treat spasticity in all MS types. Spasticity is a “common MS symptom with a clear, unmet need,” Bebo said. “I’m very anxious to hear about how well this might show out.”
• An ongoing Phase 2b trial (NCT02975349) looking at an oral small molecule called evobrutinib, by Merck KGaA (EMD Serono in U.S. and Canada), that works as a Bruton’s tyrosine kinase inhibitor and might suppress the formation of damaging and autoantibody-producing immune cells, including B-cells.
• Updates by Bruce Trapp, PhD, chair of the Cleveland Clinic’s Lerner Research Institute, who led a study that identified a new subtype called myelocortical MS, one marked by the loss of nerve cells but not damage to myelin, the protective coating on nerve cell fibers.

Bebo also prioritized work in treating young patients, particularly the results of a survey by the International Pediatric Multiple Sclerosis Study Group looking at better ways of conducting pediatric MS trials. Those findings, which Bebo thought “partly inspired by the recent approval of Gilenya” for RRMS patients beginning at age 10, will be detailed in a poster Wednesday.

“Other emerging topics,” Bebo said, delve into the “under-appreciated consequence of MS” on cognition and the speed with which information is processed. Of most interest here are studies into exercises like an at-home “video game” of sorts — “a simple digit modality test” by Akili — that “saw some very interesting improvements in processing speed that we think will translate into improvements in cognition,” he said. A poster detailing this work will be presented Thursday.

Still others are looking at diet, particularly the low-carb ketogenic diet thought to ease inflammation and oxidative stress — but whose tolerability in MS is not yet known. A small study into the keto diet, also being presented Thursday, saw changes in fatigue and depression scores in patients that Bebo thought of note.

“It’s becoming more clear that the more you can reduce your risk for other health conditions, comorbidities layered on top of MS, the better your outcome’s going to be — the slower you’ll progress,” he said.

Bebo and others with the NMSS also will keep an eye on presentations of potential biomarkers of disease progression and patient response to treatment, like serum neurofilament light chain, a blood biomarker, and various imaging markers, as well as a stem cell study that spotted potential difficulties with this high-interest treatment, and cardiac health in MS. In addition, there will be many updates on existing therapies  from post-approval studies that pharmaceuticals are continuing to do to better understand both a drug’s safety and those it might best treat.

ECTRIMS is “really a highlight for me, personally, each year,” Bebo said. “If there’s a drawback, it’s only that — because of its size — there’s at least, at any one time, two or three parallel sessions that you have to choose among. The challenge is deciding which session to go to.”