ENS 2013: 3,000 neurologists meet in Barcelona

Personalised therapy for multiple sclerosis is key factor in treatment success

Although there are myriad new treatment options for multiple sclerosis, this disease is still hard to get under control. Experts at the Congress of the European Neurological Society in Barcelona urged massive efforts to be made in pharmacogenetics so that the success and side effects of drugs on individuals can be predicted. Newly revised !S treatment guidelines put special emphasis on patient centred factors for successful treatments. Barcelona, 10 une 2013 Although the upcoming approval of new drugs against multiple sclerosis will offer a number of additional treatment options, it is important that we keep one thing in mind: The only way we can get this disease well under control is if we manage to provide personalised therapy tailored to the individual and to predict the effects and side-effects of a given drug. nfortunately these efforts are still in the early stages of development,! "rof #avier $ontalban %$ultiple &clerosis 'entre of 'atalonia, &pain( e)plained at the *+rd $eeting of the ,uropean -eurological &ociety %,-&( in .arcelona. $ore than +,/// e)perts are currently gathered there to discuss latest developments in their field. "rof $ontalban urged that more pharmacologic research be done on biomarkers and that physicians cooperate more closely with patients to optimise therapy. $ultiple sclerosis %$&( is a chronic inflammatory disease of the central nervous system characterised by a high degree of heterogeneity. The clinical course of the disease and its degree of severity can vary widely from one individual to the ne)t. 0t is now known that one and the same treatment can yield very different therapeutic results. "rof $ontalban: 1espite an awareness of this problem, personalised therapy was not an issue for a long time, not least because of the lack of options. This situation could well change in the near future.! !ighly effecti"e drugs #ut a host of risks 2e are seeing the end of a one drug fits all! approach to multiple sclerosis therapy, said "rof $ontalban. $yriad new treatment options are becoming established right now. There is a well-founded hope that we will be able to help people suffering from $& more effectively and more 3uickly in future. 2e were familiar with this disease for 4*/ years without being able to treat it. 5or 46 years, drugs have been available without noteworthy side-effects but limited in their effectiveness. 0n the meantime a number of highly effective drugs have been put on the market. 7owever, they involve risks ranging from hair loss and bradycardia to progressive multifocal leukoencephalopathy %"$8(. "$8 is a dangerous viral infection caused by the immune-suppressive effect of some drugs and can have fatal conse3uences. "rof $ontalban: 0n the meantime a test has been developed for determining the probability of patients to develop "$8. This is a welcome step in the right direction. The genetic causes of the varying effectiveness of individual types of drugs are becoming increasingly clear.! 0nterferon 9, the first disease-modifying drug that was approved, is effective on */ to 66: of patients depending on the criteria applied. This fact has led science to make great efforts to find biomarkers that reliably indicate successful treatment and side-effects. "rof $ontalban: ;ight now we are at 4// possible biomarkers without a clear tendency. This shows how comple) $& research is and how far we still have to go to achieve personalised medicine.!

$anger of changing or stopping therapy nder certain circumstances, more pharmacogenetic findings could enable e)perts to predict the conse3uences of switching therapies. The medical field remains in the dark on many aspects of this issue too, to the detriment of those affected. A 'atalonian study presented at the ,-& $eeting shows how problematic it can be to switch therapies. After five years suffering from $&, the seven study participants were medicated with the highly effective disease-modifying drug natali<umab because the previous treatment had failed. Their state of health remained stable for the average period of about *.6 years they took this substance. They then had to switch to other weaker drugs for reasons varying from "$8 risk to pregnancy and allergic reactions. 1espite the alternative medication, the patients= neurological state deteriorated 3uickly. After about three months, four of the seven sub>ects e)hibited new lesions and two of the seven were even found to have sustained ?/ new in>uries to the central nervous system. A mere eleven months later, all patients had ?/ to @/ new lesions. "rof $ontalban: 2hen patients stop taking drugs like natali<umab, they can suffer disastrous relapses with a more aggressive disease than before. 0t is therefore urgent that we devise strategies to ensure greater continuity. This task e)tends beyond pharmacogenetics and re3uires a holistic approach to treatment.! Ne% treatment guidelines take indi"idual factors into account ,vidence-based treatment guidelines on $& therapy are now being thoroughly updated in a pro>ect under "rof $ontalban=s aegis and with the support of numerous national societies in this field. This revision takes account not only of the many pharmacological innovations such as oral therapies or drugs based on monoclonal antibodies. 0t also puts special emphasis on the many individual factors that personalise a therapy and make it more successful. These factors include thoroughly advising and informing the patients before treatment begins so they can decide on a therapy option and take part in carrying it out. To this end, the new guidelines also provide informational material for patients. "rof $ontalban: 0nitially, very fundamental 3uestions have to be clarified: 2hat do patients consider a successful therapy to beA 2hat would they rather accept in this therapeutic tightrope walk: severe side-effects or early disablementA Are women planning to have childrenA! The decisive factor after that is to monitor and if need be, adapt the successful therapy. "rof $ontalban: To be successful, each therapy decision must be made in close consultation with the patients. Today, a patient-centred approach is more possible than ever before. That is because $& breaks out mostly in young adults aged */ to ?/. As a general rule, this group is digitally competent and can use the 0nternet to keep in constant contact with the physicians treating them. The e)tensive involvement of the patients is especially important with $& to increase compliance.! "rof $ontalban hopes the new guidelines will be implemented 3uickly and create greater awareness for personalised therapy options amongst general practitioners and neurologists.
Sources: ,-& Abstract " @4/: 1evelopment of a clinical practice guideline on the management of multiple sclerosis using the B;A1, methodological approachC ,-& Abstract 4DE: "ersonalised treatment of $ultiple &clerosis: &afetyC ,-& Abstract 4@4: "ersonalised treatment of $ultiple &clerosis: &hared decision-making and patient-centred careC ,-& Abstract F*+4: 'atastrophic multiple sclerosis rebound after natali<umab treatment discontinuationC 'omabella, $anuelG$ontalban, #avier %*/4*(: $ultiple sclerosis and immunological response: time for a personalised therapyA! in: 7ot Topics in -eurology and "sychiatry */4*C 4+, pp.4E-*6

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