Hot Topics and MS Research News for January 2015

Patient Expert

3-Year results from HALT-MS trial shows clinical efficacy in RRMS.

Stem cell therapy is a hot topic in MS circles and patients have been awaiting news regarding the Hematopoietic Cell Transplantation for Relapsing-Remitting Multiple Sclerosis (HALT-MS) trial. Interim results are available for this ongoing phase 2 trial of high dose immunosuppressive therapy (HDIT) with autologous hematopoietic cell transplant (HCT) for patients with active RRMS (n=25). At 3 years, 78.4% of patients were free from disease activity (as measured by confirmed loss of neurologic function, clinical relapse, or new MRI lesions) or death; 90.9% of patients were free from progression; and 86.3% were free from clinical relapse.   Adverse events were consistent with expected toxic effects associated with HDIT/HCT, and no acute treatment-related neurologic adverse events were observed. Patients experienced sustained remission and improvements in neurologic disability, quality-of-life, and functional scores.

Nash RA, Hutton GJ, Racke MK, et al. High-Dose Immunosuppressive Therapy and Autologous Hematopoietic Cell Transplantation for Relapsing-Remitting Multiple Sclerosis (HALT-MS): A 3-Year Interim Report. JAMA Neurol. Published online December 29, 2014. doi:10.1001/jamaneurol.2014.3780.

Almost half of MS patients experience tremors, according to patient reports.

Tremor is recognized as a less common symptom of MS. Among participants in the NARCOMS registry who completed semiannual surveys between fall 2010 and fall 2011, the estimated prevalence of tremor in MS patients ranged from 45-46.8%, with severe tremors affecting 5.5-5.9% of respondents. In a subset of registrants (n=552) who completed a supplemental survey, mild tremor severity was associated with younger age at MS diagnosis and onset of tremor symptoms. However, severity of tremor was not associated with duration of MS or tremor symptoms. Rates of unemployment, disability, and use of symptomatic medication increased with tremor severity, but were high even among those with mild tremor.

Rinker JR 2nd, Salter AR, Walker H, et al. Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey. BMJ Open. 2015 Jan 8;5(1):e006714. doi: 10.1136/bmjopen-2014-006714.

MS panel recommends expanding No Evidence of Disease Activity (NEDA) to include neuropsychological measures.

In the early days of MS disease-modifying therapies, the primary goals of treatment -fewer relapses, lower disability, and fewer lesions - were sufficient. However, as more has been learned about the disease, the goal of treatment has become "no evidence of disease activity" (NEDA). A panel of MS experts has proposed incorporating other aspects of disease into the NEDA model, such as neuropsychological measures including cognitive status, fatigue, depression, and quality of life, in the creation of a multifactorial multiple sclerosis decision model (MSDM). This scheme would better reflect the complexity of the disease, especially during the early inflammatory stages when EDSS measures are unable to distinguish low levels of progression. The proposed MSDM does need to be tested, but it could assist doctors and patients in making treatment decisions during the early stages of the disease.

Stangel M, Penner IK, Kallmann BA, Lukas C, Kieseier BC. Towards the implementation of "no evidence of disease activity" in multiple sclerosis treatment: the multiple sclerosis decision model. Ther Adv Neurol Disord. Jan 2015;8(1):3-13. doi:10.1177/1756285614560733.

THE UNUSUAL: ** Cinnamon holds potential as an economical and effective treatment for MS.**

Oral administration of cinnamon powder, at a dose of 50 mg/kg body weight/day, was found to suppress clinical symptoms of relapsing-remitting MS in a mouse model of the disease known as experimental allergic encephalomyelitis (EAE). Researchers found that cinnamon suppresses inflammation, preserves the integrity of the blood-brain barrier and blood-spinal cord barrier, and blocks demyelination in the central nervous system of EAE mice. This study shows that cinnamon powder upregulates anti-autoimmune Treg/Th2 cells (via reduction of nitric oxide production), down-regulates autoimmune Th17/Th1 cells, and blocks the EAE disease process when administered either prophylactically or therapeutically. The novel immunomodulatory role of cinnamon suggests that this spice may be studied as an economical treatment for MS.

Mondal S. Pahan K. Cinnamon Ameliorates Experimental Allergic Encephalomyelitis in Mice via Regulatory T Cells: Implications for Multiple Sclerosis Therapy. PLoS One. 2015 Jan 8;10(1):e0116566. doi: 10.1371/journal.pone.0116566. eCollection 2015.

Fecal microbiota transplantation (FMT) may improve MS symptoms.

Recent studies have linked gut bacteria (microbiota) to multiple sclerosis, suggesting that certain microbial imbalances in the intestines affects MS risk, inflammation, and the development of symptoms. Microbial imbalances are known to be a complication in a myriad of diseases and fecal microbiota transplantation (FMT), a microbiota-targeted therapy, has been effective in certain bowel-related disorders. The current review identifies case reports of three MS patients who underwent FMT for constipation and achieved normal defecation with virtually complete normalization of neurological symptoms, thereby improving their quality of life. In FMT, bacteria from the feces of a donor is used to manipulate the intestinal microbiota of the patient.

Xu MQ, Cao HL, Wang WQ, et al. Fecal microbiota transplantation broadening its application beyond intestinal disorders. World J Gastroenterol. 2015 Jan 7;21(1):102-111.


Arnold DL, Calabresi PA, Kieseier BC, et al. Effect of peginterferon beta-1a on MRI measures and achieving no evidence of disease activity: results from a randomized controlled trial in relapsing-remitting multiple sclerosis. BMC Neurol. 2014 Dec 31;14(1):1058. [Epub ahead of print]

Bomprezzi R. Dimethyl fumarate in the treatment of relapsing-remitting multiple sclerosis: an overview. Ther Adv Neurol Disord. 2015 Jan;8(1):20-30. doi: 10.1177/1756285614564152.

Christianson MS, Mensah VA, Shen W. Multiple sclerosis at menopause: Potential neuroprotective effects of estrogen. Maturitas. 2015 Feb;80(2):133-139. doi: 10.1016/j.maturitas.2014.11.013. Epub 2014 Nov 27.

Havrdova E, Horakova D, Kovarova I. Alemtuzumab in the treatment of multiple sclerosis: key clinical trial results and considerations for use. Ther Adv Neurol Disord. 2015 Jan;8(1):31-45. doi: 10.1177/1756285614563522.

Marrie RA, Reider N, Stuve O, et al. The incidence and prevalence of comorbid gastrointestinal, musculoskeletal, ocular, pulmonary, and renal disorders in multiple sclerosis: A systematic review. Mult Scler. 2014 Dec 23. pii: 1352458514564488. [Epub ahead of print]

Riem P, Karenberg A. MS in prose, poems and drama. Mult Scler. 2015 Jan 12. pii: 1352458514560929. [Epub ahead of print]