Advances in Multiple Sclerosis Research & Practice
Emerging Evidence in the Neuroimmunology of MS
Presented by Columbia MS Clinical Care and Research Center
A CME/CNE Activity featured on
September 23, 2018
Archived, for viewing purposes only.
Advances in the treatment of relapsing-remitting multiple sclerosis (RRMS) have reshaped the way clinicians and patients approach this disabling chronic disorder, which affects individuals in their most productive working and childbearing years and is a significant cause of disability. Today in 2018, management consists of first-generation agents and has expanded to include oral agents, as well as longer-acting formulations of disease-modifying therapies (DMTs). Additionally, ocrelizumab, a humanized monoclonal antibody designed to selectively target CD20-positive B cells, is the first drug for primary progressive disease, as well as for relapsing MS. In addition, recent evidence suggests an emerging role for selective immune reconstitution therapy (SIRT) in the treatment of RRMS. Thus, for the treating clinicians, although this broad and expanding therapeutic repertoire improves individualized management of MS, it also makes choices more complex and challenging.
For both general neurologists and MS specialists, fundamental appreciation of the immunopathology of MS will lead to a better understanding of the disease course and an appreciation of the emerging MS therapeutics that are now, more than ever, tailored to the intricacies of the immune system. Two decades of clinical experience with immunomodulatory treatments for MS point to distinct immunological pathways that drive disease relapses and progression.
In light of the current understanding of MS immunopathology, clinicians need to evaluate long-standing hypotheses regarding the role of the immune system in the disease and delineate key questions that although still unanswered but beginning to produce emerging evidence and novel treatments, as investigators study the opportunity to reset the immune system. Recent and anticipated advances in the field of immunology, and the increasing recognition of inflammation as an important component of neurodegeneration, are shaping the conceptualization of disease pathophysiology, encouraging clinicians to grasp the potential implications for improved healthcare delivery to their patients in the future.
After attending this educational activity, participants should be able to:
- Explain the immune-mediated mechanisms of MS that may serve as immune targets for therapeutic interventions
- Review the mechanisms of action, efficacy and safety of current & emerging therapies
- Describe the immunological rationale, safety, and clinical data supporting an immune system reset (i.e., therapeutic role of lymphopenia)
- Assess the efficacy and long-term safety of selective immune reconstitution treatment in RRMS
- Evaluate the impact and risks of continuous immunosuppression (i.e., opportunistic infection)
- Summarize the concept of immunosenescence
- Effectively monitor older MS patients receiving immunomodulatory and immunosuppressive treatment for risk of infection
- Compare and contrast immune reconstitution therapies (IRTs) with conventional maintenance/escalation therapies (METs)
- Describe strategies to assess and manage MS symptoms and comorbidities
- Utilize treatment goals, disease and patient-related factors, and benefit/risk considerations when selecting treatments for relapsing-remitting disease