Allison Gandey

October 14, 2010

October 14, 2010 (Gothenburg, Sweden) — Patients who develop relapsing-remitting multiple sclerosis later in life and who have less inflammation are more likely to respond to immunomodulating therapies, report researchers.

Presenting here at the 26th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, investigators described demographic, clinical, and imaging predictors of response to first-line therapies.

The retrospective, single-center study included 1203 patients with multiple sclerosis. Patients were followed up every 3 months and underwent brain magnetic resonance imaging once a year.

Predictors of full response to immunomodulating therapies.

At 2 years, 36% of patients experienced a full response defined as no relapse during treatment and no T2 or T1 active lesions. Fewer patients, 27%, had a partial response and 37% did not respond to treatment.

The team, led by Giancarlo Comi, MD, from the Scientific Institute San Raffaele in Milan, Italy, then broke response rates down by type of immunomodulating therapy.

Patients taking once-a-week interferon beta had a similar response at 37%, and those taking multiweekly interferon beta had a rate of 34%. Patients taking glatiramer acetate faired better at 42%.

The investigators tested potential predictors of response using a multivariate logistic regression model. They found older age at disease onset and less inflammatory activity predicted response to therapy. However, the researchers caution, the relatively short duration of follow-up may limit the reliability of the finding over a longer period.

Patients who responded well to therapy at 1 year tended to continue to enjoy the benefits of treatment at 2 years. After a year, 68% of patients had a complete response, and this persisted until the end of the study.

Asked by Medscape Medical News to comment, Sidney Spector, MD, from the Veterans Affairs Medical in Phoenix, Arizona, said he would have expected that patients with less disease burden would respond better to treatment. "I'm not surprised patients with less inflammatory activity responded well, but I'm not sure I would have anticipated that age at onset would be a factor," he said. "I think that one could have gone either way, so this is interesting."

Individualized Medicine

Dr. Spector says this work helps highlight the trend toward individualized medicine.

This is something Dr. Comi's team reports it will continue to pursue in new studies of the same cohort. The investigators are currently exploring how genetic variability or neutralizing antibodies alter response to therapy.

A new article published in September in Nature Reviews Neurology outlines the 7 multiple sclerosis genome-wide association screens that have been completed in recent years. These findings have substantially lengthened the list of genetic risk associations for multiple sclerosis, Jorge Oksenberg, MD, and Sergio Baranzini, MD, from the University of California at San Francisco, point out.

Still, they add, "our knowledge of multiple sclerosis genetics remains incomplete, with many risk alleles still to be revealed, although progress is likely to be rapid in the near future." The ensuing challenge, they note, will be to design effective functional studies that convincingly link genetic variation to the underlying pathophysiology of disease. "Such connections might translate into clinically useful genetic biomarkers and reveal novel targets for therapy."

As it stands now, Dr. Comi's team points out, the clinical response to immunomodulatory treatments is extremely variable. "Predictors of response are necessary."

Dr. Comi reports receiving financial support from Novartis, Teva, Sanofi-Aventis, Merck, Bayer Schering, and Biogen.

26th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS): Poster 505. Presented October 14, 2010.

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