Congress highlights
In this section
This year, over 8,700 people attended the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held on the 26th–28th of October 2022.
At the congress, we invited Professor Bernhard Hemmer, Dr Victoria Leavitt and MS patient advocate Dominic Shadbolt to share their highlights and key insights from presentations and discussions at the event. To hear Professor Hemmer’s and Dr Leavitt’s key insights, click play below.
Join Professor Hemmer and Dr Leavitt for their key insights from ECTRIMS 2022.
Hear patient advocate Dominic Shadbolt’s perspective on the congress.
High-efficacy therapies and treatment decisions
The first hot topic that kicked off Wednesday morning was “High Efficacy Therapies (HET)”.
Xavier Montalban discussed early predictors of treatment outcomes, and how prognostic factors can inform treatment decisions, particularly with high efficacy therapies (HET). He presented data from the RADIANCE1 and SUNBEAM2 trials, in which increased dose of ozanimod (1 mg vs. 0.5 mg) in males decreased treatment efficacy.
Understanding the baseline factors that contribute to poor diagnosis, notably older age, male sex, higher expanded disability status scale (EDSS) ratings, and inflammatory factors, are key for predicting poor diagnosis, and may be involved in poor responses to treatment. HETs can overcome these hurdles in relapsing remitting multiple sclerosis (RRMS).
Montalban emphasised people with poor prognostic factors should be treated with HET early, within the first 6 months of clinically isolated syndrome (CIS)
Here, Professor Hemmer shares insights on the importance of early and personalised treatment after MS diagnosis to minimise disease progression, and the shift towards earlier use of HETs.
MS patient advocate Dominic Shadbolt outlines the MS treatment landscape, how high-efficacy treatments fit into management, and the importance of minimising disease progression following diagnosis.
Dr Dalia Rotstein presented optimal timings for switching to high-efficacy disease modifying therapies (DMTs), particularly in early intensive therapy, since no published clinical trial data can offer guidance on switching. Current guidelines for switching and criteria for escalating therapy differ slightly, between monitoring at 6 and 12 months, to within the first 2 years, or earlier3–5. Serum neurofilament light (sNFL), a novel biomarker, could be used to evaluate disease activity in clinical practice.
See an example of using sNFL to monitor treatment response from the ECTRIMS 2022 congress site (log-in required)
Regarding escalating MS treatment before discontinuation, a panel agreed that age, disease stability, and radiological data were important factors. Dr Eva Striijbis proposed studies investigating the effects of pre/post-menopause on MS disease activity data are challenging to design, as it is not possible to accurately randomise participants.
MS treatment in pregnancy
Hear Professor Hemmer’s perspective on key considerations for treating pregnant women with MS, noting recent data presented at ECTRIMS 2022 on the safety profile of anti-CD20 treatments in pregnancy.
Several speakers discussed MS treatment during pregnancy. Depending on the patient and treatment type, some women should continue MS therapy, while others should be bridged to another therapy.
View a study on family planning for women with MS from the ECTRIMS 2022 congress site (log-in required)
Dr Karen Chung noted that although continuing therapy is an option, and glatiramer acetate was more “pregnancy friendly” than interferon, some women are reluctant to adhere to medication during pregnancy. Practitioners should work closely with their patients to make personalised treatment decisions. Concentrations of biomarkers, such as natalizumab, may guide these decisions in the future.
Learn more about interferon beta exposure during pregnancy and breastfeeding from the ECTRIMS 2022 congress site (log-in required)
Multiple sclerosis clinical trials
Diroximel furamate can provide better tolerance, and should be chosen over dimethyl furamate (DMF)6. It has been approved in the US for relapsing MS (RMS) since May 2020, and in the European Union and UK since 2022.
- The EXPERIENCE Phase 4 trial is evaluating the long-term efficacy and safety of diroximel fumarate for MS7
- KYRIOS, a phase 4 study investigating immune response to SARS-CoV-2 mRNA vaccines in people with MS, either before or at least 4 weeks after beginning treatment with ofatumumab, an anti-CD20, is underway8
- The question of whether HETs are superior to moderate DMTs is being explored in two trials, Traditional Versus Early Aggressive Therapy for Multiple Sclerosis Trial (TREAT-MS)9, and Determining the Effectiveness of earLy Intensive Versus Escalation Approaches for RRMS (DELIVER-MS)10
Quality of life, psychological factors and MS symptoms
Quality of life (QoL) was a large talking point at this year’s ECTRIMS. Dr Victoria Leavitt explores how considering psychological factors and quality of life can help produce a more comprehensive picture of the patient, influencing treatment decisions.
Professor Leavitt’s latest research for treating psychological factors in MS focused on three main factors: disclosure and concealment, social isolation/loneliness and self-efficacy, and agency.
Leavitt described a person who had had MS for many years and had recently divorced, so he was dating for the first time with MS. He had been open about his diagnosis with his ex-wife, but now he faced the challenge and discomfort of deciding when to disclose his diagnosis to new potential partners. In response, Leavitt developed the Diagnosis Disclosure and Concealment in MS (DISCO-MS), a self-assessment tool for understanding disclosure and concealment11.
Leavitt discusses research from her laboratory on this topic, and how diagnosis concealment can be associated with a person’s diagnosis experience.
Findings from Dr Leavitt’s latest research indicated 77% of people with MS had never discussed disclosure/concealment with their practitioner, and 49% conceal their diagnosis
Leavitt and her team created the online support resources eSupport12 and eFit13, as part of the SUNLIGHT14 and CONNECT trials15, to combat social isolation/loneliness in people with MS.
View results of using body-mind therapy to improve QoL for people with RRMS from the ECTRIMS 2022 congress site (log-in required)
MS and fatigue
Dr Federica Picariello discussed MS-related fatigue and challenges of fatigue treatment. Over other factors, fatigue has the largest effect on QoL, and is the main reason people with MS become unemployed. Picariello emphasised interactions between fatigue and other factors, such as the sleep-wake cycle, anxiety, and fear of further relapses.
See a poster on the influence of demographics and clinical factors on fatigue from the ECTRIMS 2022 congress site (log-in required)
Balance exercise, and cognitive behavioural therapy can improve fatigue in people with MS, although individual preference for fatigue treatments and exercise type is key.
Dr Leavitt explored questioning people with MS about fatigue, and methods to help manage it.
Rice and colleagues found 22.74% of people with MS said their life had little purpose or meaning, with the odds of purposelessness being higher in females. Including people with MS in their treatment decision and personalising care is key. Hear an expert's perspective.
Living with MS - a patient’s perspective
MS patient advocate Dominic Shadbolt describes advances in the MS treatment landscape. He suggests methods to improve management of MS, from the patient perspective.
ECTRIMS 2022 provided new developments and thoughtful, insightful discussions on how we can ultimately put people with MS first and give them greater agency in their lives
We caught up with experts in multiple sclerosis (MS) to gain key insights into topics of particular interest at the congress. Join Professor Bernhard Hemmer and Dr Victoria Leavitt to hear highlights from presentations and discussions at the congress.
Read on below to explore further insights, new research and developments at ECTRIMS 2022.
The importance of early and personalised treatment in MS
Professor Hemmer shares insights from ECTRIMS 2022 on the importance of early and personalised treatment after MS diagnosis to minimise disease progression, and the shift towards earlier use of high-efficacy therapies. He provides tips on treatment decisions and how to manage discussions about treatment selection using a collaborative, shared-decision making approach.
MS treatment in pregnancy
Professor Hemmer discusses some key considerations for treatment of pregnant patients with MS, noting recent data presented at ECTRIMS 2022 on the safety profile of anti-CD20 treatments in pregnancy.
Weighing up the risks and benefits of treatment for MS
Join Dr Leavitt in exploring essential factors for weighing up treatment options for MS, including the importance of helping patients navigate the complicated MS treatment landscape, the relevance of ‘guided’ treatment decision-making, and how open communication can facilitate informed treatment decisions.
Infections and vaccinations in MS
Is there evidence to suggest infections can trigger MS? When should vaccination be considered for people with MS? Professor Hemmer explores these questions and highlights clinical implications of evidence from ECTRIMS 2022.
Psychological factors and quality of life in MS
Considering MS is a heterogenous disease affecting many aspects of a person’s life and has a variable symptom profile, Dr Leavitt describes the importance of considering psychological factors and quality of life to obtain a more complete picture, which can inform decisions about optimal treatments.
Dr Victoria Leavitt describes research from her laboratory on how often people with MS conceal their diagnosis from others, and its association with their diagnosis experience.
Non-pharmacological management of MS
What can be done to address cognitive impairment in MS?
Many people with MS experience cognitive changes, which can lead to functional limitations in daily life. Dr Leavitt explores the latest evidence on cognitive impairment in MS, and how this can influence management.
Managing fatigue in MS
Fatigue is a symptom that occurs for many people with MS and can impose daily life challenges. Dr Leavitt explores the importance of questioning people with MS about fatigue, and methods for management.
How can lifestyle changes and exercise assist with management of MS?
Dr Leavitt describes the impact of managing modifiable lifestyle factors on people with MS, including how suitable management can increase their sense of agency and wellbeing.
Lived experience with MS: A patient’s perspective
As someone who has been living with MS for 28 years, MS patient advocate Dominic Shadbolt shares his perspectives on disease management, current treatments, and how to improve the patient experience. Watch below to hear his insights.
Meet the experts
Professor Bernhard Hemmer
Professor Hemmer has been director of the Department of Neurology at the TUM-Klinikum Rechts der Isar since 2007. He is a specialist in the field of inflammatory diseases of the nervous system, in particular multiple sclerosis. Scientifically, he is involved in studies on the cause, course and treatment of multiple sclerosis.
Disclosures: Professor Hemmer received honorarium from EPG Health to participate in this event.
Dr Victoria Leavitt
Dr Victoria Leavitt is a neuropsychologist and neuroscientist, specialising in the cognitive and psychological sequelae of multiple sclerosis. Dr Leavitt is Assistant Professor in the Department of Neurology at Columbia University Irving Medical Center, where she maintains a faculty practice within the MS Center. For over ten years, Dr Leavitt’s research has focused on symptoms affecting quality of life for people living with MS, including cognitive impairment, fatigue, depression, anxiety, and loneliness. Dr Leavitt’s laboratory conducts research on interventions to facilitate management of MS. In 2019, she launched eSupport Health (www.esupporthealth.com), a digital health platform delivering group-based, targeted behavioural treatments to people with MS. The company is currently conducting a clinical trial of online support groups for people of colour living with MS.
Disclosures: Dr Leavitt is a recipient of grants from the National Institutes of Health, the United States Department of Defense, and the National Multiple Sclerosis Society.
Mr Dominic Shadbolt
Dominic Shadbolt is a patient advocate living with MS. He received his MS diagnosis in 1994, is currently 53 years of age, and recently achieved both a BA and an MSc. Dominic is married with a 19 year-old daughter, and lives near Oxford in the UK. He is about to start his fifth disease-modifying therapy (DMT), and is a proponent of exercise. As an active member of the MS community, Dominic started a YouTube channel in March 2021 called www.theMSguide.com, where he talks with patients and professionals about MS from a purely patient perspective. Dominic has prior experience in consulting, sales, technology and pharmaceuticals, and founding and selling a successful business.
Disclosures: Dominic has provided insight and expertise as an advisor, consultant or presenter for the following companies: Novartis, Sandoz, EPG Health, MS Trust, MS Society, LivedHealth MS, Barts and the RLH MS Treatment Group, Boster.ms, European MS Forum, MS Brain Health Initiative, and Camstech. Dominic has received honoraria for presentations from shift.ms, LivedHealth MS, EPG Health, and Novartis.
References
- Cohen JA, Comi G, Selmaj KW, Bar-Or A, Arnold DL, Steinman L, et al. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial. Lancet Neurol. 2019;18(11):1021–1033.
- Comi G, Kappos L, Selmaj KW, Bar-Or A, Arnold DL, Steinman L, et al. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial. Lancet Neurol. 2019;18(11):1009–1020.
- Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scl J. 2018;24(2):96–120.
- Freedman MS, Devonshire V, Duquette P, Giacomini PS, Giuliani F, Levin MC, et al. Treatment optimization in multiple sclerosis: Canadian MS Working Group recommendations. Can J Neurol Sci. 2020;47(4):437–455.
- Rae-Grant A, Day GS, Marrie RA, Rabinstein A, Cree BA, Gronseth GS, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurol. 2018;90(17):777–788.
- Faissner S, Gold R. Efficacy and Safety of Multiple Sclerosis Drugs Approved Since 2018 and Future Developments. CNS Drugs. 2022;36(8):803–817.
- US National Library of Medicine. Study of Diroximel Fumarate in the Real-World Setting. 2022. Available at: https://clinicaltrials.gov/ct2/show/NCT04746976.
- US National Library of Medicine. Exploring the Immune Response to SARS-CoV-2 COVID-19 Vaccines in Patients With Relapsing Multiple Sclerosis (RMS) Treated With Ofatumumab (KYRIOS). 2022. Available at: https://clinicaltrials.gov/ct2/show/NCT04869358.
- US National Library of Medicine. Traditional Versus Early Aggressive Therapy for Multiple Sclerosis Trial (TREAT-MS). 2022. Available at: https://clinicaltrials.gov/ct2/show/NCT03500328.
- US National Library of Medicine. Determining the Effectiveness of earLy Intensive Versus Escalation Approaches for RRMS (DELIVER-MS). 2022. Available at: https://clinicaltrials.gov/ct2/show/NCT03535298.
- Kever A, Leavitt VM. Assessing diagnosis disclosure and concealment in multiple sclerosis: Development and initial validation of the DISCO-MS survey. Mult Scl J. 2022;28(2):247–256.
- Leavitt VM, Riley CS, De Jager PL, Bloom S. Esupport: Feasibility trial of telehealth support group participation to reduce loneliness in multiple sclerosis. Mult Scl J. 2020;26(13):1797–1800.
- Leavitt V, Riley C, De Jager P, Bloom S. eSupport and eFIT: Internet-based targeted behavioral interventions for persons with multiple sclerosis (310). Neurol. 2020;94.
- US National Library of Medicine. SUNLIGHT Study: Online Support Groups for MS to Address COVID-19. 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT04379661.
- US National Library of Medicine. CONNECT Trial of eSupport Online Health-coach Moderated Support Groups for Multiple Sclerosis (CONNECT). 2022. Available at: https://clinicaltrials.gov/ct2/show/NCT04943887.
Developed by EPG Health for Medthority. This content has been developed independently of the sponsor Novartis Pharma AG, who have had no editorial input into the content. EPG Health received unrestricted educational funding from the sponsor in order to help provide its healthcare professional members with access to the highest quality medical and scientific information, education and associated relevant content. Opinions expressed by the experts and patient advocate in videos are based on personal/clinical opinions and experience, and are not to be interpreted as representing the opinions or beliefs of Medthority or EPG Health.