Research News from ECTRIMS
- European Committee for Treatment and Research in Multiple
Sclerosis, October 6 - 9, 2004
A better understanding of the disease process
in MS, good news for people with MS who are considering pregnancy,
and improvements in symptom management were among the highlights
of the 20th Congress of the European Committee for Treatment
and Research in Multiple Sclerosis (ECTRIMS) and the ninth annual
meeting of Rehabilitation in Multiple Sclerosis (RIMS) held
This year's ECTRIMS, held October 6-9 at
the Vienna Austria Centre, set a record attendance with more
than 3000 scientists, clinicians, and nurses participating in
the four days of meetings and poster presentations.
Following are highlights from the ECTRIMS
meeting. In addition, the scientific program, including abstracts
of some presentations, is available here.
Reducing MS relapse in pregnancy
Treatment with intravenous immunoglobulins
will reduce MS relapse rates during pregnancy and following
delivery. This was the conclusion of researchers from Israel
who confirmed the findings made by other researchers that treatment
with intravenous immunoglobulins, following delivery, reduces
the rate of MS relapses. Unlike previous studies, however, this
study treated women with MS with intravenous immunoglobulins
during pregnancy and following delivery.
Dr. A. Achiron reported a reduction in relapse
rates in women with relapsing-remitting MS (RRMS) taking intravenous
immunoglobulins during pregnancy and following delivery. In
her concluding remarks, Dr. Achiron urged clinicians to consider
other ways to reduce the incidence of post-partum-related relapses
in women with RRMS.
In an update on the Pregnancy-related relapse
in multiple sclerosis (PRIMS) study, Dr. C. Confavreux, confirmed
that breast-feeding does not influence relapse rates. The PRIMS
study showed that relapse rates declined during pregnancy, most
notably in the third trimester, and increased in the three months
Both researchers noted that preliminary findings
on the use of intravenous immunoglobulins before, during, and
after pregnancy have been encouraging to date.
Results of teriflunomide study in
Dr. Paul O'Connor (St. Michael's Hospital,
Toronto) and colleagues reported that teriflunomide - an immunosuppressive
agent that may modulate activity of disease-causing immune cells
- was well tolerated in a randomized, placebo-controlled study
of 179 people with relapsing-remitting MS, and significantly
reduced areas of damage to nerve-insulating myelin, as seen
Participants were randomly assigned to receive
placebo, or 7 mg or 14 mg of teriflunomide, once daily for 36
weeks. The primary objective of the study was to determine the
effect of treatment on the average number of active areas of
myelin damage (lesions), as seen on MRI scans taken every six
Both treatment doses were associated with
reduced numbers of active lesions compared with placebo-treated
subjects. Adverse events included headache and upper respiratory
tract infection; the number of such events was similar among
all three groups. The researchers concluded the results warrant
further study of this drug in a larger trial, which is in the
planning stages now.
New information on the four immunomodulatory
treatments currently available for the treatment of RRMS - glatiramer
acetate (Copaxone), interferon-beta 1a (Avonex, Rebif), and
interferon-beta 1b (Betaseron) - was presented at several symposia
and through dozens of posters.
The use of high-dose interferon and the long-term
benefits of immunomodulatory treatments were among the most
important treatment advances at this year's congress. Some researchers
are evaluating treatment with higher doses of interferon to
control MS and prevent relapses. Others are exploring ways to
maintain treatment benefits in the long-term.
A US study evaluating 10 years of continuous
use of Copaxone in 251 people found that more than 60% of people
with MS, who remained on therapy, showed clinical improvement
and stable disability scores.
Researchers and clinicians continued to grapple
with the definition of primary-progressive MS (PPMS) and RRMS
by asking the question: Are these one or two diseases?
Researchers agreed that the majority of MS cases are RRMS with
distinct episodes, commonly called relapses. Up to 15 years
after the first onset of RRMS, about 50% of people have difficulty
with mobility and enter a phase of increasing disability without
necessarily having relapses. They are defining this presentation
as the secondary-progressive phase of MS.
To these researchers, PPMS is a different
disease which presents in about 10%-15% of people with MS who
experience progressively increasing disability from the start.
This presentation of PPMS differs from RRMS in several respects.
The average age of onset of PPMS is significantly later by about
five years and the majority of PPMS cases have progressive weakness
affecting the lower extremities.
Other researchers defined RRMS and PPMS as
a two-staged disease with two consecutive mechanisms underlying
the progression of disability - inflammation and neurodegeneration.
They report a time-difference between phase one and phase two
of the disease. The early phase of the disease appears to be
strongly influenced by ongoing inflammation. The second phase
has a progressive course which is more suggestive of an ongoing
neurodegenerative process. This progressive phase of MS is associated
with irreversible disability.
ECTRIMS 2004 delegates were invited to spend
a half-day at the Rehabilitation Clinic in Bad Pirawarth. Since
1998, the Pirawarth Clinic has been the largest hospital clinic
in Austria dedicated to neurorehabilitation. Most of the clinic's
235 beds are devoted to neurology rehabilitation. People with
a variety of illnesses and associated physical limitations are
evaluated and treated by a multidisciplinary team of 12 physicians,
80 therapists, nurses, and other health care professionals.
The philosophy of care at the Pirawarth Clinic
is to build on the elementary functions that are still available
and restore people to a jointly-defined level of functioning.
In a separate presentation, researchers from
Brazil outlined a two-pronged approach to rehabilitation. Their
rehabilitation program focused on cognitive function, fatigue,
depression, and quality of life. The therapists used education
to modify beliefs about fatigue symptoms and an aerobic program
to improve physical capacity. They found that multidimensional
progress provided positive results to people with MS regarding
aerobic capacity, symptoms of depression and fatigue, and quality
of life (QoL) perceptions.
Cognitive impairment and fatigue were among
the most discussed topics as this year's congress. Sessions
on the impact of spasticity on fatigue, exercise therapy for
balance and mobility, and the use of assistive equipment provided
clinicians with a broad overview of new and developing interventions
aimed at improving the lives of people with MS.
Researchers at the Cleveland Clinic Foundation, Cleveland USA
contributed to the growing body of information on cognitive
impairment by alerting clinicians to the fact that people with
MS may demonstrate cognitive performance that is less than predicted
but not low enough to meet formal criteria for cognitive impairment.
Researchers reported that this low level of cognitive impairment
will still have a negative impact on QoL.
In this study, a group of 136 people with
MS were assessed in different domains of cognitive function.
Among other measures, the researchers evaluated verbal comprehension,
perceptual organization, processing speed, working memory, immediate
memory, general memory, and auditory delayed recognition. They
found lower than expected processing speed in people with MS
who did not meet the criteria for cognitive impairment.
ECTRIMS 2004 showcased a number of studies aimed at better defining
and managing fatigue. Presentations of fatigue and pain, fatigue
and rehabilitation, and fatigue and activities and daily living
were among the most interesting.
The clinical impact of fatigue during neurological inpatient
rehabilitation was examined by researchers from Denmark who
found that fatigue has a high clinical impact in the rehabilitation
of people with MS. These clinicians were able to reduce fatigue
during four weeks of in-clinic rehabilitation without specific
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