The NeurologyLive staff compiled highlights from our discussions with experts in one convenient location, following ECTRIMS 2021.
The 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), October 13-15, featured hundreds of presentations, conversations, and updates with experts in the care of patients with multiple sclerosis (MS).
The virtual conference covered topics such as the use of integrative medicine (IM) in MS and the latest data for investigational agents, such as ATA188 in progressive MS, data on the efficacy and safety of ublituximab (TG Therapeutics), as well as results from a phase 2 study that evaluated autologous mesenchymal stromal cells secreting neurotrophic factors cells in patients with progressive MS.
The NeurologyLive team sat down with several leaders in the MS field, learning more about key findings, while also gaining additional insight into areas for future research, the use of telehealth, and takeaways from ECTRIMS 2021 overall.
The use of IM for patients with MS may offer unique benefits; however, associated costs and lack of insurance coverage for these types of approaches often restrict accessibility. Megan Weigel, DNP, APRN-C, APHN-C, MSCN, spoke with NeurologyLive on the “Inspire Multiple Sclerosis” program, also known as “Inspire MS,” which she developed as a 6-week workshop to introduce a variety of IM modalities to patients with MS.1
Weigel, who is the founder of First Coast Integrative Medicine in Jacksonville, presented findings from the program at ECTRIMS 2021, noting that resultant data was surprising. Participants joined weekly sessions via Zoom, filling out the Multiple Sclerosis Self-Efficacy Scale (MSSE), the MS Wellness Questionnaire, and the 36-Item Short Form Survey (SF-36) at the start of the program, as well as at the 6-week mark. While patient evaluations were “glowing,” Weigel noted that she and colleagues found no to negative effect on both the MSSE and the MS Wellness Questionnaire, as well as positive effect based on means in only a few scales of the SF-36.
As Bridget A. Bagert, MD, MPH, director, Multiple Sclerosis Center, Ochsner Health, explained in a conversation with NeurologyLive, literature collected in the last decade has lent credence to the thought that the root cause of MS is Epstein-Barr virus–infected B cells. For this reason, now, Atara Biotherapeutics is developing a novel agent that targets these cells.
The therapy, ATA188, is an allogeneic T-cell immunotherapy for patients with progressive MS, has been evaluated in a phase 1/2 clinical trial, with results recently presented at ECTRIMS 2021. The data include magnetization transfer ratio (MTR) measurements and suggest that the therapy has a sustained clinical benefit over 39 months. Ultimately, the MTR for unenhancing T2 lesions showed a correlation with EDSS at 6 months (n = 21; ρ = –0.4180; P = .0594) and at 12 months (n = 23; ρ = –0.3539; P = .1062), with the findings suggesting evidence of a potential remyelination effect based on the increases in MTR associated with EDSS scores.2
Bagert, an investigator in the trial, shared her insight into the data and her reaction to the potential shown by these results, despite their early-phase nature. Atara Bio is continuing its investigation of the therapy in an ongoing and enrolling phase 2 portion of the study, called EMBOLD (NCT03283826), which is expected to read out interim results in early 2022.
Data from the identical phase 3 ULTIMATE 1 and 2 trials (NCT03277261; NCT03277248) were presented at the 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), October 13-15, outlining the safety and efficacy of a 1-hour infusion of ublituximab (TG Therapeutics) every 6 months, with an initial infusion of 150mg over a 4-hour period, in patients with relapsing multiple sclerosis. Lawrence Steinman, MD, Zimmermann Professor of Neurology and Neurological Sciences, and Pediatrics at Stanford University, sat down with NeurologyLive to discuss findings from both trials, which met their primary end point in significantly reducing annualized relapse rate (ARR) and MRI parameters over a 96-week period, compared to teriflunomide (Aubagio; Sanofi).3
Steinman, the principal investigator for both trials, outlined data on ublituximab, an investigational glycoengineered anti-CD20 monoclonal antibody, and commented on the results, which were “virtually identical” to the previous phase 2 trials. The time-effective nature of the treatment is another appealing aspect, Steinman said, as the process takes 1 hour every 6 months, and with ublituximab having been glycoegineered, infusion time is reduced.
At ECTRIMS 2021, investigators presented key data from a phase 2 study that evaluated autologous mesenchymal stromal cells secreting neurotrophic factors (MSC-NTF) cells in patients with progressive MS. These cells are induced to increase secretion of neuroprotective and immunomodulatory molecules and may address compartmentalized central nervous system inflammation. The trial featured 18 patients with progressive MS who had mean Expanded Disability Status Scale scores of 5.4
At the conclusion of the 28-week treatment period, 14% and 13% of treated patients showed 25% improvements in timed 25-foot walk and 9-Hole Peg Test. In comparison, no patients from the Comprehensive Longitudinal Investigation of Multiple Sclerosis, or CLIMB, registry (n = 48), the study’s matched cohort, achieved these outcomes during comparable follow-up. The therapy also demonstrated relevant cerebrospinal fluid biomarker outcomes as well.
Lead author Jeffrey Cohen, MD, director, Mellen Center for MS Treatment and Research, Cleveland Clinic, and president, Americas Committee for Treatment and Research in Multiple Sclerosis, sat down with NeurologyLive to discuss the presentation. He provided context on the need for alternative therapies for patients with progressive MS, and why the mechanistic action of MSC-NTF cells pose as an intriguing option.
Looking for more from ECTRIMS 2021? The virtual conference may have ended October 15, but our coverage of presentation highlights is ongoing! Be sure to check back here for updates on the latest data readouts and additional interviews with leaders in the care of patients with multiple sclerosis.