The 2018 American Academy of Neurology (AAN) Annual Meeting was recently held in Los Angeles, CA, on April 21st to the 27th, with more than 40 leading researchers presenting the latest advances in neuroscience. The following is an overview of some of the newest findings in multiple sclerosis (MS) from the meeting.
Serum neurofilament light chain as an MS biomarker
Three phase 3 clinical trials were evaluated to investigate whether blood tests for serum neurofilament light chain (sNfL) may hold value as a biomarker for monitoring disease severity and treatment response in patients with MS.
Peter A. Calabresi, MD, and colleagues, found that levels of sNfL were associated (P < 0.00001) with both the number of enhancing lesions and T2 lesion volume. The team found that sNfL levels were low and stable in patients without disease activity, compared with the higher and variable levels in those patients with MS.
Moreover, sNfL levels were decreased in the experimental treatment arms, with the most effect seen in those participants receiving natalizumab.
Ibudilast in progressive MS
Ibudilast was associated with a reduction in brain atrophy in patients with progressive MS, according to Robert Fox, MD, and colleagues.
In a phase 2 trial, researchers randomized 255 patients to either an experimental group that received up to 100 mg/day of ibudilast or to a placebo group. During a 96-week period, they evaluated clinical outcomes and imaging every 24 weeks; brain parenchymal function was used to determine brain atrophy.
Results showed that administration of ibudilast was associated with a 48% reduction in brain atrophy progression. In addition, safety and tolerability profiles were favorable.
Treatment lead times in MS
A study by Thor A. Chalmer, MD, showed that MS patients who started treatment with disease-modifying therapy (DMT) later experienced a shorter time to reaching Expanded Disability Status Scale (EDSS) 6—or confirmed disease worsening. However, measures of mortality did not differ.
The Danish researchers performed an observational study using two nationwide registries. They suggested that the results of this study support earlier treatment with DMT in those with MS.
Predicting socioeconomic outcomes in MS
On the basis of a large training sample that was subsequently validated using a separate cohort, Carl de Moor, PhD, and other researchers, identified clinically meaningful benchmarks of cognitive performance in participants with MS.
Specifically, Processing Speed Trial (PST) scores correlated with socioeconomic outcomes in MS patients even after adjusting for age, sex, and education.
Interim analysis of the OBOE study
In an interim analysis of the OBOE (Ocrelizumab Biomarker Outcome Evaluation) study, researchers found that cerebrospinal fluid (CSF) NfL levels decreased at 12 and 24 weeks post-treatment with ocrelizumab in patients with relapsing and primary progressive MS.
Moreover, Amit Bar-Or, MD, FRCP, FAAN, FANA, and colleagues, found that NfL levels correlated with CSF B- and T-cell numbers, “suggesting continued reduction in axonal injury with ocrelizumab treatment, and that levels of CSF inflammatory cells may predict neuronal injury.”
Additionally, ocrelizumab was generally well tolerated and consistent with safety in phase 3 studies.