Multiple Sclerosis: Treat Early With High-Efficacy Therapy

At the joint meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), Stephen Hauser, MD, of the University of California San Francisco, spoke during a plenary session titled, “MS: Pathway to a Cure.”

In this exclusive MedPage Today video, Hauser follows up his synopsis of the first portion of his session with an explanation on the importance of high-efficacy therapy and the benefits of starting treatment early in multiple sclerosis (MS).

Following is a transcript of his remarks:

The next part of my seminar focused on the increasing and now overwhelming data that, for treatment of MS, earlier is better. And immediately beginning with high-efficacy therapy is better than a graded approach where low-efficacy therapies are begun early on and then there is a treat-to-target approach where as patients have breakthrough disease, there is increasingly higher efficacy therapy used. So treat early and treat with high-efficacy therapy for the majority of patients who present with MS.

And I presented data showing that the long-term outcomes of early initiation of high-efficacy therapy is more favorable than beginning with lower efficacy therapy. Once disability occurs, there’s no catch up. So we want to prevent disability by using highly effective therapy as early as possible.

The next part of my talk spoke about the high efficacy of B-cell directed therapies and the incredible benefits of anti-CD20 B-cell based therapies on the inflammatory component of MS, and the incremental benefits of CD20 therapies on the progressive neurodegenerative component for MS. I spoke about what we would need to do to completely eliminate ongoing progression in patients who are continuing to have percolating worsening, simmering progression after inflammation has been completely blocked with therapy.

And the bottom line is that in addition to B cells, new therapeutics that target microglial cells and probably CD8 cytotoxic T cells will be required. So our therapeutic armamentarium — looking towards the future if we are going to advance from the complete suppression to cure — will consist of treat earlier. The earlier is better. And for patients with established MS, treat with high-efficacy therapies. And hopefully down the road, therapies that target not only B cells, but microglial cells could be the most effective approach for patients with MS.

The world of MS research is incredibly exciting. It’s getting even more exciting for young people entering the field today. I’m particularly optimistic about our prospects to move from complete suppression of relapsing disease, our current state of the art, to complete suppression of all components of MS, the relapsing as well as the progressive phase of the disease. And the therapies that are now in late stage clinical trials that, in my opinion, have the greatest chance of achieving this goal are therapies that target the B cell and plasma cell kinase, Bruton’s tyrosine kinase, or BTK. So BTK inhibitors have an outstanding opportunity to treat not only the relapsing phase of the disease, which is mediated by B cells, but the progressive phase of the disease mediated by plasmablasts and microglial cells, both of which are selectively targeted by BTK inhibitors.

So we’ve come so far in the field over the past 40 years, and I think that we are going to see opportunities to do even better in the near term. And there’s a good chance that multiple sclerosis will become the first chronic autoimmune disease which potentially can be cured.

The low-hanging fruit to be able to cure MS will be in patients whose disease is just beginning today, and down the road patients whose disease has not yet begun, but who have the biomarkers indicating that MS is in their future. So treating very early with high-efficacy therapy will be the key to better control of MS. Many thanks.