Direct from American Academy of Neurology Meeting

Reporting live from Washington, DC.

Multiple sclerosis in children is becoming increasingly recognized.  The focus has been on earlier diagnosis.  Many children can have only one attack such as optic neuritis or ADEM (acute disseminated encephalomyelitis) in which multiple active areas of inflammation occurred in the brain and spinal cord.   Data was presented on MRI findings and environmental factors (low vitamin D levels and Epstein-Barr virus exposure) that predict risk of developing multiple sclerosis.

Daclizumab data was presented.  In the DECIDE Trial,  1841 patients were randomized to daclizumab or Avonex.   Daclizumab reduced new relapses by 54%,  reduced contrast-enhancing lesions by 65% and reduced confirmed progression of disability at 6 months by 27%.   Infections and skin reactions (37%) were higher on daclizumab.

SMART study examined 2455 multiple sclerosis patients treated with Gilenya.  Only one patient had symptoms from low pulse.  LONGTERMS study of patients on Gilenya for an average of 4 years results showed no increase risk of infection in patients with low lymphocyte (type of white blood cell) counts.  Low lymphocytes was defined as absolute lymphocyte count <0.4 for 60% or more of labs checked on treatment.

Lemtrada-treated patients with no previous treatment with multiple sclerosis treatment generally had good 4 year response.  Forty-two percent of patients actually had improvement in disability and 31 % of patients remained stable despite very active disease entering the trial.

JC virus index has been useful in examining PML risks.  Of a group of 68 patients with PML without previous immunosuppressive medication exposure, only 2 patients (2.9%) had a JC virus index less than or equal to 0.9.  Since PML can be fatal,  Tysabri risks must be weighed against treatment benefits.