More than 9,000 researchers, healthcare providers, and advocates from 110 countries gathered in October in Milan, Italy or remotely to share progress in advancing cures for multiple sclerosis.
MSMilan23 was the 9th Joint ECTRIMS-ACTRIMS Meeting (European Committee for Treatment and Research in MS-Americas Committee for Treatment and Research in MS). Below are only a few highlights of many important presentations, grouped according to three
Pathways to Cures that will
stop MS,
restore function, and
end MS by preventing new cases.
- Follow the links provided below to read the scientific summaries (abstracts) of the highlighted studies, or browse all of the program and abstracts
- Listen to a podcast at Real Talk MS featuring an interview about ECTRIMS highlights with advocate/National MS Society Board Member Bonnie Higgins and the Society’s Chief Advocacy, Services, and Science Officer, Dr. Tim Coetzee
- Listen to day-by-day professionals-level podcasts by ECTRIMS of meeting highlights:
Usually, study results presented during conferences like this are considered preliminary until they are published in peer-reviewed journals.
STOPPING MS
There were many presentations demonstrating continued benefits of available disease modifying therapies, and longer-term safety data showing that early and ongoing treatment has long-term benefits for controlling disease activity, delaying buildup of disabilities, and protecting quality of life. For example:
- Dr. Elena Flavia Mouresan (Karolinska Institutet) reported that the risk of transitioning from relapsing MS to secondary progressive MS has been steadily decreasing over nearly 20 years in people tracked in the Swedish MS Registry. It now occurs later in life and at a longer time after the onset of MS, possibly as a result of the use of disease-modifying therapies. (Abstract)
Closer to cures: Dr. Stephen Hauser (University of California, San Francisco) gave the opening lecture describing advances that have been made to get us closer to cures. He noted that the powerful disease-modifying therapies that nearly stop all relapses have made researchers more aware that there can be silent progression underlying MS in the absence of relapses (referred to as Progression Independent of Relapses or PIRA). Research to understand the underlying mechanisms of MS disease activity and nervous system damage, including silent progression, was a prevalent theme during MSMilan23. These included:
- Genes and inflammation: Dr. Kathryn Fitzgerald (Johns Hopkins University, Baltimore) and Dr. Lucas Schirmer (University of Heidelberg, Germany) collaborated – with funding from the National MS Society – to study individual cell types in the optic nerve. Inflammation of the optic nerve is often one of the first MS symptoms. The scientists used advanced techniques to look at genes and the cell types they instruct in 1,561 people with MS, to see if there was any connection to optic nerve symptoms in these individuals. The results show that lasting optic nerve inflammation was linked to genes instructing immune B cells, star-shaped housekeeping cells known as astrocytes, and cells that line the brain. These studies continue and may help explain how inflammation smolders in different parts of the brain. (Abstract)
- Fatty acids influence MS activity in teens? Dr. Vinicius Schoeps (University of California, San Francisco) and colleagues from the National MS Society-supported U.S. Network of Pediatric MS Centers analyzed more than 2,000 fatlike molecules (lipids) in blood samples from 446 teens with MS. Lipids are important to the immune response in MS. The team found that Omega-3 fatty acids (contained in foods like fish, walnuts, and chia seeds) were linked to significant decreases in the risk of MS relapses and disease activity on MRI scans. On the other hand, Omega-6 fatty acids (contained in oils from sunflowers, corn, soybeans, and other foods) were linked to increased risk of disease activity. Further study is necessary to determine whether supplementation would be of value, and if so, at what dose and for what duration. (Abstract) Take charge of nutrition in MS at any age
Many presentations focused on understanding what various biomarkers under study can tell us about treatment response, disease activity, and future prognosis. This work underway will greatly inform clinical trials and pave the way for precision medicine for people with MS. For example:
- Previously, Dr. Robert Fox led a clinical trial called SPRINT-MS that tested a therapy called ibudilast in people with progressive MS and found that on average people in the ibudilast treatment group had a reduced rate of brain shrinkage (atrophy) than the control group. Looking back at blood serum and spinal fluid samples taken at the start of the trial, Dr. Fox and collaborators found evidence that serum biomarkers called GFAP (Glial fibrillary acidic protein, shed from brain astrocytes during injury) and NfL (neurofilament light chain, shed from nerve cells during injury) both showed strong links to MRI measures of brain tissue injury, with GFAP even stronger. Spinal fluid levels weren’t more informative. This adds to growing evidence that GFAP is a relevant biomarker of tissue damage in progressive MS. (Abstract)
There are several experimental therapies making their way through stages of testing for progressive as well as relapsing MS whose modes of action are distinct from those of approved therapies. These include “BTK inhibitors,” which may address damaging immune activity inside the brain that is thought to drive progressive disability. Several BTK inhibitors are in phase 3 trials and results are expected in late 2023 through 2025. Other studies of note included:
- Early study of experimental therapy with nasal dosing: Dr. Tanuja Chitnis (Brigham and Women’s Hospital, Boston) and team tested a drug given in the nose that targets a molecule (CD3) that activates immune T cells. In a small phase 1 study of foralumab in 6 people with non-active secondary progressive MS, there were signs that the drug may have positive effects with few side effects. The team is planning a larger, controlled clinical trial. (Abstract)
- More powerful therapies for children and teens with MS: Two large international studies examined whether using higher efficacy MS treatments, such as natalizumab or ocrelizumab, in children and teens with MS would be safe and effective. Lower efficacy therapies such as glatiramer acetate are currently the first line of treatment for this group. Dr. Nail Benallegue (University of Anger, France) and colleagues found that higher efficacy treatment reduced the risk of a first relapse by 54% more than lower efficacy treatment. (Abstract) Dr. Sifat Sharmin (University of Melbourne) and colleagues found that – in more than 5,000 children/teens with MS – treatment with higher efficacy therapy reduced the risk of disability worsening more than lower efficacy therapy. (Abstract) Get resources for navigating the journey of pediatric MS
- Ocrevus trial in underrepresented populations: To understand the safety and effectiveness of Ocrevus in people who were not well represented in the trials that led to the approval of Ocrevus, Dr. Mitzi Williams (Joi Life Wellness Center, Atlanta) and colleagues are conducting the CHIMES trial, an open, unblinded trial involving 113 Black and 69 Hispanic/Latinx people with relapsing MS. The team recruited people across the U.S., Puerto Rico and Kenya, supporting inclusive enrollment by providing study materials in different languages, reviewing materials for cultural appropriateness, and offering financial incentives such as compensating for lost earnings. After one year of this ongoing study, about half of the participants had no evidence of disease activity, and over 90% experienced no relapses. The side effects that occurred were similar to those in the pivotal trials. (Abstract)
Learn more about MS in the Black and Hispanic Latinx communities
- Women’s health: A session focused on questions around pregnancy, breast feeding and menopause. Evidence is emerging on how to reduce the possibility of postpartum relapses, and highlights the need for planning pregnancy when possible, to reduce chances of fetal exposures. More research is needed to understand infant safety in terms of using disease-modifying therapies while breastfeeding. Watch presentations from the Female Health session.
Read more about reproductive issues and MS
RESTORE – Reversing Damage
Studies to protect the nervous system and promote regeneration are underway. An ongoing issue is how to quickly detect whether repair has been successful. Several presentations showed progress toward this goal using advanced MRI, optical coherence tomography (OCT) and positron emission tomography (PET). Additional noteworthy studies included:
- Mesenchymal stem cells and cognition: Research to understand the potential of individuals’ own mesenchymal stem cells (MSC - adult stem cells found in bone marrow, skin, fat and other tissues) to stop inflammation and promote myelin repair in MS has been ongoing. Drs. Petrou Panayiota, Dimitrios Karussis and team (Hadassah University Hospital, Jerusalem, Israel) are conducting an extension to a previously reported trial of MSCs in 48 people with active progressive MS which suggested benefit. For this ongoing extension study, the participants are undergoing cognitive testing and their blood levels of biomarkers are being tested. So far the results suggest some benefit in cognition and reductions in blood biomarkers (sNfL and GFAP) that reflect brain tissue damage. (Abstract)
- New myelin repair study underway: Drs. Anna-Victoria De Keersmaecker, Barbara Willekins (University of Antwerp, Belgium) and team have received funding from the National MS Society to test the ability of the diabetes therapy metformin to protect the brain and promote myelin repair in people with non-active progressive MS. They presented their study design and plan to enroll 120 participants across Belgium. They will be looking for improvements or stabilization of walking speed, cognition and other measures of disability and also MRI-detected brain volume. (Abstract)
- Measuring visual repair: Dr. Sam Hof (Amsterdam UMC) and colleagues used infrared oculography, a noninvasive measure of eye movement, to evaluate 14 people with MS and a vision problem known as misalignment or INO. Within one year, the problem resolved in 7 of these people, perhaps a signal of the spontaneous repair that can occur in people with MS, but that does not persist. Among the participants who improved, there was reduced fatigue and driving difficulties, and improvement in function on the EDSS disability scale in certain functions. The results indicate that this might be a simple way to measure repair, but confirmation is needed in larger numbers of people with MS. (Abstract)
Get tips for managing vision problems in MS
RESTORE – Restoring Function
There is growing attention to finding ways to better track how people are doing day-to-day, in between infrequent clinic visits. For example, you can watch this overview of wearable and digital technologies by Dr. Anneke van der Walt of Australia, and the opportunities and issues they present (
view the presentation). Studies of note included:
- Swallowing problems and awareness: Dr. Paolo Ragonese (University of Palermo, Italy) and colleagues evaluated swallowing in 86 people with MS. While nearly 80% had some degree of swallowing problem, only 26% were aware of having difficulties. There were links between swallowing scores and the EDSS disability scale, indicating that swallowing problems might be an “invisible symptom” associated with worsening function. (Abstract) Do you know about the stages of swallowing and what problems might be related to MS? Get tips for managing them
- Cognitive rehabilitation rebuilding the brain? Adding to recent results of a large clinical trial that compared cognitive rehabilitation, exercise, both together, or a sham control group, Dr. Maria Assunta Rocca (Italy) showed that a computer-based program to improve cognition (with or without aerobic exercise) was linked to increases in brain tissue volume. This imaging study was funded by the National MS Society. (Abstract)
- Weight loss program success: Being overweight or obese can worsen MS. Dr. Jared Bruce (University of Missouri- Kansas City) and colleagues tested a weight loss intervention in 71 people with relapsing MS who were obese. Features included telehealth groups, individual coaching, calorie restriction, increasing fruits/vegetables, technology aids (FitBit, Lose It app), and 150 minutes weekly of moderate to vigorous physical activity. People were randomly assigned to the intervention or a control group that got a brief education program. The intervention group lost an average of 8.6% of body weight, vs. 0.7% in the control group. Forty-one percent lost 10% or more of their body weight. The study was funded by the National MS Society. (Abstract) Watch a webinar on creating healthy habits with MS
ENDING MS
The
Pathways to Cures Roadmap defines Ending MS as no new cases of disease – meaning preventing the disease so that no one ever hears the words, “You have MS.” One strategy to prevent MS is to identify and limit exposure to modifiable MS risk factors. Dozens of MSMilan23 presentations focused on understanding how the
Epstein-Barr virus (EBV) is involved in launching and even possibly sustaining MS disease activity. Studies of note included:
- EBV and the immune system: Dr. Thomas Berger (Medical University of Vienna, Austria) presented results of a study comparing immune systems of people with high levels of EBV-targeted antibodies in their blood, some of whom have MS and some of whom do not. They found that the people without MS tended to have high levels of immune natural killer cells capable of eliminating autoimmune reactions such as what are thought to be triggered by EBV. Having specific MS-linked immune genes (HLA) that inhibit natural killer cells substantially increased the risk of MS. More work is needed to continue to unravel the role of EBV in MS. (Abstract)
- Sunlight or vitamin D? Vitamin D is associated with reduced risk of MS, but it’s unclear whether it’s the vitamin itself or sunlight exposure, which increases levels of vitamin D. Akash Kapali (University of Bergen, Norway) and colleagues looked at vitamin D intake in more than 70,000 women enrolled in the Norwegian Mother and Child Cohort Study and identified those who developed MS through the country’s MS registry. Norway has insufficient sun-induced vitamin D production during most of the year. Higher intake of total dietary vitamin D was linked to a 37% lower risk of developing MS, supporting the idea that vitamin D itself is the source of this association. (Abstract)
Learn more about vitamins, minerals and herbs in MS
- Global research effort: The newly formed Global MS Research Strategy Group, representing major MS research organizations around the world, commissioned a study to better understand the landscape of MS research by non-profit and government organizations worldwide. Top-line results were presented, indicating that at least 1305 research projects have been funded by 16 non-profits including the National MS Society during 2021-2023. These projects are valued at over €379 million ($390 million) and represent all three Pathways to Cures categories.
This analysis highlights potential areas for an enhanced research effort and multidisciplinary collaboration. Global cooperation and alignment of resources will accelerate progress towards knowledge, treatments, and cures for MS. MS organizations have jointly declared their collective commitment to a global research strategy to accelerate cures for MS. (Poster)
These and many other presentations at MSMilan23 make it clear that thousands of researchers focusing on pathways to cures are making critical advances toward the day when there are solutions for everyone living with MS.