MS News That Caught My Eye Last Week: AHSCT, Ocrevus, CD20 T-cells, Spasticity App
National MS Society Supports Stem Cell Transplant for Select, Aggressive RRMS
Bravo! This statement is welcome after the recommendation of National Multiple Sclerosis Society advisers that autologous hematopoietic stem cell transplant, or AHSCT, could be useful for people younger than 50 and recently diagnosed with MS. Now, how long will it take for insurance companies and government medical plans in the U.S. to pay for AHSCT for people with MS? Unfortunately, I’m not holding my breath.
The National Multiple Sclerosis Society supports the use of a patient-derived bone marrow transplant to treat people with very aggressive relapsing-remitting multiple sclerosis (RRMS) who responded poorly to disease-modifying therapies (DMTs).
This position is in line with a recent set of society recommendations about how and in whom autologous hematopoietic stem cell transplant (AHSCT) should be performed. Published last year, they were based on a systematic review of recent clinical evidence related to AHSCT use in MS patients. …
AHSCT is an intensive, experimental treatment approach that uses a person’s own, or autologous, healthy blood cell progenitors — also known as hematopoietic stem cells — to stop MS-related immune attacks on the brain and spinal cord.
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#ECTRIMS2021 – Early Ocrevus Slows MS Better Versus 2-year Delay
This report from the virtual 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) supports the philosophy that it’s best to hit MS hard and fast, at least when it comes to treatment with Ocrevus. I suspect this may be true for other top-line disease-modifying therapies (DMTs), too. Where possible, neurologists and their MS patients should opt for one of the high-efficacy DMTs from the get-go. At least do a risk-benefit analysis of these medications.
Early use of Ocrevus (ocrelizumab) continues to significantly slow disability progression after 7.5 years in people with relapsing multiple sclerosis and after eight years in those with primary progressive MS, according to new analyses of Phase 3 trial data comparing immediate use with a two-year delay in starting therapy.
Also, the treatment’s safety profile remained consistent with that previously reported, supporting a favorable benefit-risk profile with long-term therapy.
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#ECTRIMS2021 – CD20-positive T-cells May Be Early Drivers of MS
Also from ECTRIMS, this research offers a possible explanation for why some people being treated with Ocrevus and Kesimpta show evidence of continued disease activity in the first few months of treatment — but not afterward. Researchers think that activity may be due to some CD20 T-cells being present in the brain before treatment starts. Those cells continue to generate inflammation. Because the anti-CD20 therapies kill cells in the blood but not the central nervous system, they don’t knock out those cells in the brain. But other disease-driving cells are killed in the blood before they are able to get to the brain, thus the delayed response.
Certain types of T-cells that express a protein marker called CD20 may be early drivers of disease activity in multiple sclerosis (MS), new data shows.
These research results were revealed last week at the 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), in an oral presentation titled “Cellular immune profiling pre- and post-aCD20 therapy points to differential effects on CD4+ and CD8+ T cells and implicates CD20-expressing CD8+ T cells in MS disease activity.”
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#ECTRIMS2021 – App’s Use Prolongs Gains of Spasticity Rehab Program
Don’t get the wrong impression about this program. It required a lot more than just using an app. It involved four weeks of patients doing a variety of 85 exercises, designed and guided by a group of physiotherapists. Patients whose spasticity improved were then assigned to a 12-week self-training program, half using an MS spasticity app and half using a conventional instruction booklet. The app played 30-minute exercise videos and contained reminders and other items aimed at motivating patients to complete the exercises. The booklet only provided exercise pictures.
Are you surprised that people who used the app saw their spasticity further ease, while those guided by the booklet showed a trend toward spasticity worsening? I’m not.
Four weeks of an anti-spasticity rehabilitation program significantly lessened leg spasticity and improved strength and mobility in people with multiple sclerosis (MS), according to data from a multicenter study in Austria.
These benefits were sustained after the program ended, when patients continued rehab with a 12-week and individualized program given using a newly designed app, but not when delivered through a conventional, illustrated booklet.
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