Year in Review: Multiple Sclerosis
One of the first questions asked by multiple sclerosis (MS) experts in 2021 still arises today: How can people with MS best protect themselves against SARS-CoV-2?
As of January 13, the National MS Society advised most people with recurrent and progressive forms of MS to get vaccinated against COVID-19. “The risks of the COVID-19 disease outweigh the potential risks of the vaccine,” company experts wrote. In addition, members of the same household and close contacts should also receive a COVID-19 vaccine when available to reduce the impact of the virus.
As vaccines became increasingly available throughout the year, a study in Italy found no additional short-term risk of relapsing MS after COVID-19 vaccination.
SARS-CoV-2 infection and MS
In 2020 and 2021, the risks associated with SARS-CoV-2 infection in MS were apparent. Earlier this year, data from COViMS, a registry supported by the Consortium of MS Centers, the National MS Society and the MS Society of Canada, showed that disability and advanced age in MS patients were linked. to poorer COVID-19 results.
As of October, with data from 3,452 patients entered into COViMS, the risks faced by disabled patients with MS were clear. Among non-ambulatory patients with COVID-19, 24.6% had been hospitalized, 8.3% had been in intensive care or on a ventilator, and 14.0% had died. In contrast, 7.5% of fully ambulatory MS patients with COVID had been hospitalized, 2.0% had been in intensive care or on a ventilator, and 0.6% had died (P
Immune responses to COVID-19
In August, a study in France showed that the antibody response to SARS-CoV-2 after infection was reduced in MS patients receiving anti-CD20 drugs like ocrelizumab (Ocrevus) and rituximab ( Rituxan). In October, growing evidence suggested that responses to the COVID-19 vaccine were also different in MS patients treated with anti-CD20 drugs – and with sphingosine-1-phosphate receptor modulators (S1P ) – compared to other disease-modifying therapies (DMT) for MS. .
At this year’s European Committee for Multiple Sclerosis Treatment and Research (ECTRIMS) congress, Joseph Sabatino Jr., MD, PhD, University of California, San Francisco (UCSF), reported that Vaccine-induced antibody responses were quantitatively normal in patients with MS. on glatiramer acetate (Copaxone), dimethyl fumarate (Tecfidera) and natalizumab (Tysabri), but were reduced in patients receiving S1P receptor modulators or anti-CD20 therapies. MS patients on S1P receptor modulators had altered vaccine-specific CD4 T cell responses, while patients on anti-CD20 therapies had intact CD4 and CD8 vaccine-induced cell responses, Sabatino said.
Also at ECTRIMS, Mihir Kakara, MD, of the University of Pennsylvania, Philadelphia, showed that anti-CD20 drugs dramatically reduced spike-specific and receptor-specific memory B cell and antibody responses in most MS patients after COVID-19 mRNA vaccination. The effect has been improved with longer durations since the last anti-CD20 treatment, Kakara said. All MS patients on anti-CD20 DMT in the study generated antigen-specific CD4 and CD8 T cell responses after vaccination.
New treatments for MS
In March, the FDA approved oral ponesimod (Ponvory), an S1P receptor modulator, to treat relapsing forms of MS, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.
Also in March, the agency gave the green light to the Portable Neuromodulation Stimulator (PoNS), a device that generates electrical pulses on the tongue to treat gait deficits in MS patients with mild to moderate symptoms.
Investigational drugs continued to be evaluated throughout the year. In two phase III trials, ublituximab, a monoclonal antibody targeting CD20, reduced relapse rates compared to teriflunomide (Aubagio) in relapsing MS. In a phase IIb study, tolbrutinib, a Bruton tyrosine kinase inhibitor (BTK), reduced new brain lesions active in relapsing MS. Post hoc analysis showed that another BTK inhibitor, evobrutinib, lowered serum neurofilament light chain (NfL) levels in a phase II trial of relapsing MS.
Real world results
Further research assessed serum NfL as a marker of disease progression in 2021. At the annual meeting of the Americas Committee for Multiple Sclerosis Treatment and Research (ACTRIMS) in February, Elias Sotirchos , MD, of Johns Hopkins University in Baltimore, reported that Serum NfL has been associated with clinical disability and brain atrophy in MS and has shown that diabetes, smoking, and BMI can affect levels by NfL.
Also at ACTRIMS, Riley Bove, MD, of UCSF, reported that patients with MS were more than four times more likely to be hospitalized for UTIs and kidney infections than matched controls. And a Mendelian randomization study presented at the conference by Adil Harroud, MD of UCSF, suggested that the relationships between MS and depression did not appear to be causal.
Later that year, a population-based paired cohort study in England showed that people with MS and depression were more likely to die over a 10-year period than people without any illness. A Canadian case-control study found that 10 years after breast cancer diagnosis, women with MS had a higher death rate than women without MS.
As the COVID-19 pandemic persisted into 2021, neurologists and other MS clinicians continued to embrace telemedicine. At ACTRIMS, Mitchell Wallin, MD, MPH, of George Washington University in Washington, DC, said 76% of MS providers across the country who responded to an online survey had used telemedicine to see patients .
At the ECTRIMS meeting in October, Marisa McGinley, DO, of the Cleveland Clinic in Ohio, demonstrated that mixing telemedicine and office visits can produce results similar to just the in-person care of the SEP.
“This is an important finding because one of the main concerns for patients and providers is that if a patient does not show up to the office, is it possible that we are causing harm? McGinley said MedPage today. “This study provides initial evidence that the results were similar to in-person care, which is reassuring.”
Other MS stories reported this year include:
PML Reported in a Patient with MS Treated with Ocrelizumab
Drug flops reused in MS trial, but study design a big winner
Black MS patients see faster B-cell repopulation
Fewer relapses in active secondary progressive MS with high-efficacy therapies
Cannabis use is common among people with MS
Treatment of MS: aggressive or escalating early therapy?