*This program is subject to change Should new therapies be subjected to clinical trials even with poor scientific support (e.g. high dose vitamin D, HBO)
Capsule: Over the past three decades, numerous disease-modifying therapies (DMT) and one symptomatic treatment were approved for multiple sclerosis (MS). All DMT are anti-inflammatory, and they were approved because they demonstrated a reduction in the frequency of disease relapses and the occurrence of new brain MRI lesions. Dalfampridine was approved because it improves the ability of patients with MS to ambulate. Many of the clinical issues that impact MS patients negatively are currently not addressed by approved medications. These include disease progression in patients with no disease activity, cognitive problems, mood issues, and others. A strong biological rationale established in preclinical animal models or in vitro experiments often leads to full clinical trial programs. Most pharmacological agents that are developed are never approved for clinical use. In this session, the debaters will outline the pros and cons of developing pharmacological interventions based on limited scientific evidence. Host: Olaf Stuve, USA Yes: Ralf Linker, Germany Are MS patients at increased risk for developing cancer?
Capsule: Whether people with MS are at higher risk of developing cancer has not been definitively established. The increased rate of general comorbidity in MS and the shared environmental and lifestyle risk factors would indicate a higher risk of cancer; on the other hand, some register and large cohort studies have not found a positive association. Could it be that there is higher risk of specific cancers, but not all cancers? And can newer data that include the increasingly used highly potent immunosuppressive treatments modify the long term data from registers? Host: Cris Constantinescu, UK Yes: Ali Manouchehrinia, Sweden No: Melinda Magyari, Denmark Are the 2017 MS McDonald criteria too liberal and should be more restrictive?
Host: Ralf Linker, Germany Yes: Brian Weinshenker, USA Does OCT make VEP redundant?
Host: Abhijit Chauduri, UK No: Mario Habek, Croatia Discussion and rebuttals Newly diagnosed MS patients should be started on aggressive therapy
Capsule: It is well established that early treatment is superior to late treatment and improves long-term prognosis in MS. Recent studies also suggest that early aggressive therapy with potent immunosuppressive drugs (“induction therapy”) may result in improved long-term outcomes and a lower risk of conversion to secondary-progressive MS. Therefore, it is plausible that newly diagnosed MS patients should be started on such aggressive therapies. However, these therapies may be associated with serious risks that should be weighed against their benefits. Should we consider all newly diagnosed MS patients for initial aggressive treatment? Do the potential benefits of aggressive therapies always outweigh their risks? Host: Jera Kruja, Albania Yes: Ron Milo, Israel No: Uros Rot, Slovenia MS is a primary progressive disease in all cases, but some patients have superimposed relapses In MS, patients with significant cognitive decline, drug treatment should be modified.
Capsule: Approximately 50% of people with MS become unemployed with a median EDSS of 3.0-3.5. They usually acquired hidden disabilities related to cognitive impairment. Should be modified drug treatment of these patients? Host: Laszlo Vecsei, Hungary Add a new agent: Ron Milo, Israel Do not change: Thomas Berger, Austria Neither: Amos Korczyn Cognitive decline is sufficient to define transition to SPMS.
Yes: Klaus Schmierer, UK No: Thomas Berger, Austria We are well enough equipped to identify fake news in MS before it can cause harm.
Yes: Klaus Schmierer, UK