Latest developments in MS research:
1. Read about the guidelines of the Association of British Neurologists (ABN) on the use of disease-modifying therapies.
2. Know more about the influence of menopause on MS.
3. Discover how a blood sample could help predict disability worsening.
These noteworthy MS news highlights and more are included in our recently published ECTRIMS Research Updates – a 30-day snapshot of global news and publications on MS research, treatment, and care.
ECTRIMS Research Updates can be sent to you every month, delivered straight to your inbox, via our free subscription service. Simply select all “topics” that are of interest to you, and when one of those appears in our news and publication cycle, you’ll be sure to hear from us.
Clinical
Serum biomarkers at disease onset for personalised therapy in multiple sclerosis
Serum biomarkers can help predict disability worsening in MS, multicenter study shows.
Measuring serum levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) at disease onset can help predict disability worsening in MS. It is what a multicenter study – conducted across 13 European hospitals between 1994 and 2022 – shows. Serum biomarkers levels were collected within 1 year from disease onset and before starting treatment. Higher sNfL values in 725 individuals with MS were associated with elevated risk of relapse-associated worsening (RAW) and of reaching a score of 3 at the Expanded Disability Status Scale (EDSS). Higher sGFAP levels were associated to a higher risk of reaching an EDSS score of 3 and, when combined with low sNfL values, to a higher risk of developing progression independent of relapse activity (PIRA). High-efficacy DMTs could not reduce the risk of PIRA in individuals with either high levels of both sNfL and sGFAP or low sNfL and high sGFAP levels.
Rehabilitation
To halt disease progression rehabilitation in MS should start early: Yes
Multiple Sclerosis Journal | 15 November 2024
Four principles guide rehabilitation: prevention, restoration, compensation, and adaptation. And yes, starting it early is crucial.
Early rehabilitation can help manage different challenges before they become limitations in daily life. Physical activity is a core aspect of rehabilitation for individuals with MS, enhancing overall functioning and well-being. Various exercises during rehabilitation can help work on balance, gait, and cognition. When restoration is not any longer possible, compensation strategies are crucial to limit impairments and maintain an active lifestyle. Compensatory strategies are also available to assist with cognitive tasks, for example remembering future activities like taking medications. Rehabilitation should be timely and address all the individual challenges in daily life.
Guidelines and Recommendations
Using disease-modifying treatments in multiple sclerosis: Association of British Neurologists (ABN) 2024 guidance
BMJ Journals Practical Neurology | 20 November 2024
The Association of British Neurologists (ABN) has updated its recommendations on the use of disease-modifying therapies (DMTs) in MS, helping face key clinical challenges.
Individuals with active MS should be offered the appropriate DMT as early as possible. High-efficacy therapy should be the first option, when needed. These are just some of the recommendations from ABN. The guidelines address several major challenges clinicians face in daily practice, including the use of generics, and starting, monitoring, switching, de-escalating, and discontinuing therapies. Best practice for equitable access to DMT are discussed. ABN recommends to regularly talk about family planning with people with MS. Women should not be discouraged from starting treatment due to pregnancy plans. And, when switching DMT, women should be able to access similar or higher efficacy therapies that show superior safety in pregnancy. Furthermore, the ABN supports the appropriate use of autologous hematopoietic stem cell transplantation (AHSCT) and advocate for extending its availability in the UK.
Women’s Health
The influence of menopause on multiple sclerosis
European Journal of Neurology | 27 November 2024
New study shows that there is no significant difference in disease progression in women before and after menopause.
The study measured disease progression in terms of annual relapse rate and scores on the Expanded Disability Status Scale (EDSS). 559 women in the peri- and postmenopausal period were included and 386 men. After menopause, women progressed slower than men in the same age, as indicated by the EDSS. But no difference was observed in the annual relapse rate. No significant difference was observed in EDSS progression and annual relapse rate in women 5 years before and after the menopause.
Therapeutics
Smouldering-associated worsening or SAW: the next therapeutic challenge in managing multiple sclerosis
Multiple Sclerosis and Related Disorders | December 2024
“We are moving in a new era where our therapeutic targets will change” (p. 3)
Smoldering MS refers to processes within the central nervous system (CNS) that are associated with neurodegeneration but occur independently of acute inflammatory disease activity. Smoldering-associated worsening (SAW) results from various pathological processes in the CNS, which could become potential targets for new therapies. Gaining a deeper understanding of these mechanisms will be crucial for developing neuroprotective treatments, some of which are currently under investigation. Additionally, lifestyle factors can be addressed to manage MS more effectively through a more holistic approach. In the future, combining different therapies will likely become the standard approach. This shift will have an impact not only on the clinical management of individuals with MS, but also on the design of clinical trials.