ECTRIMS 2007 Therapy papers

QD v QOD GA suggests possible role of qod therapy. Khan plans 3 arm study multicenter randomized of daily v qod v weekly.

Perfumal et al. Uses IIS (intense immunosuppression) as inital therapy in active rrms patients. In active patients used 6 months of monthly cytoxan before beginning DMT first line, with good results on clinical and MRI outcomes.

Mancuso et al. JC virus has 9.8 % prevalence in CSF,mostly asymptomatic.

Imaging studies at ECTRIMS 2007

Calabrese et al. Used double inversion recovery (DIR) sequences to assess cortical lesions over 24 months in rrms, found more cortical lesions in untreated patients.

Haacke et al. SWI (susceptibility weighted imaging) to detect/quantify tissue iron; on 1.5 T machine, 78/141 lesions were seen on SWI only in gray and white matter; on 3 T machine, 20 lesions were seen on SWI only (our of 90 lesions); on 4 T machine 45/116 lesions were seen on SWI only. Iron content found 47 ug.gm higher than normal.

Kahn O. et al. B Cell response (CSF IgG index) correlates with gray matter atrophy in clinically aggressive disease.

Complications after 5 years of DMT in MS

Caon C. et al
Copaxone-- 89 % had local injection site reactions and 78 % had lipoatrophy. No other complications were significant.

SQ IFN B- 38 % flu like reactions, 68 % local injection site reactions, 11 % injection site necrosis, 41 % lipoatrophy, 8 % abnl LFT and 8 % abnl CBC, 25 % headache

IM IFN B-- 22 % flu like 18 % local injection site reaction, 24 % severe post injection reaction, 6 % abnl LFt, 9 % headache.

Injection compliance five years into continuous therapy:
taking 90% or more scheduled injections per month: SC IFn >70, im IFN 58, GA 20 %
taking 70-90 % of scheduled injections per month: all 3 around 20 %
taking <70% of injections: GA around 60, IM IFN about 25, SQ IFN <10 %

Hits Ectrims 2007 HHV6, Vit D, Rebound

Marmocets who were injected with HHV6 got subpial inflammation and parenchymal demyelination, those who did not get injected did not get it. The suggested causal mechanism is CNS persistence of HHV6A and direct toxicity to cells, with resultant apoptosis.

_Genain CP et al.
Blogger note-- HHV6 is so ubiquitous in humans its impossible to study, as almost 95 % prevalence exists in human population

Vitamin D-Correale et al. In vitro, Vitamin D effects are very similar to interferons. 1,25 Vit D inhibits proliferation of CD4+ cells, enhances IL 10, decreases IL 6, increases number of CD4 and CD 25 regulatory cells.
Blogger notes-- amounts being studied in clinical trials are manifold higher than the amount available and are potentially extremely toxic. Also, vitamin d levels are of little use.

Stopping DMT: No rebound Bejaoui et al. Stopping ifn or GA did not result in more relapses than continuing therapy. Blogger notes--only one year followup was offered with no MRI evidence. What happens in year 2?