The news (and a desire) emerged in Amsterdam from the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis
More and more personalized therapies, new molecules under study, a holistic approach to patient care and a dream: to find a drug capable of replenish myelin. These are some of the innovations (and a desire) that emerged in Amsterdam from the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), the most important event in the world dedicated to multiple sclerosisa disease that, experts are keen to point out, is no longer a sentence to the wheelchair as it happened 25-30 years ago.
Personalized care
It is estimated that in the world about 2.8 million people suffer from multiple sclerosis. a chronic inflammatory autoimmune disease which today is kept under control with increasingly personalized therapies. Choosing the right complicated care: the balance of the immune system is very delicate and it requires reactivity and balance, like a tightrope walker 30 meters above the ground. Except in rare cases, on the one hand, heavy immunosuppression cannot be exceeded because the patient is exposed to the risk of infections or tumors; on the other hand, a mild treatment cannot be prescribed because when the immune system is too “lively”, as in the case of multiple sclerosis, the response must be turned off – he explains Luca Battistini, director of the Neuroimmunology laboratory at the Santa Lucia IRCCS Foundation in Rome -. Today you have them available about twenty effective authorized therapies, with different mechanisms of action. It is necessary to find the most advantageous one by evaluating the risk-benefit costs according to the patient in front of you. Studies go in the direction of identify the immune profile of sick subjects to find biomarkers (such as neurofilaments that are now entering clinical practice) that identify the subpopulation of cells that create the damage and “suggest” the best therapy for that subject. There are many variables that affect: age of the patient, clinical history, historical context as we have seen in recent years with Covid, environment and lifestyles. Exposure to the sun to develop vitamin D, physical activity, a healthy diet and respect for the sleep-wake rhythm appear to be associated with a reduced risk of developing multiple sclerosis, while excessive use of antibiotics, obesity, smoking and alcohol are all potentially involved in the development of autoimmune diseases. The typical inflammation of subtle multiple sclerosis, always present even if no new lesions appear on MRI. For this reason it is essential to start as soon as possible with a targeted and more effective drug and, at the same time, to imagine the possible change in the therapeutic protocol with the advancing age of the patient who undergoes immunosenescence. This means a lower liveliness of the immune response and therefore the need for a readjustment of the treatment protocol. Lifetime therapyas happens for a patient suffering from arterial hypertension.
Turn off inflammation
Among the therapies that seem promising and that, still in the experimental phase, are showing long-term benefits in patients with the relapsing form treated for more than three and a half years are a new class of drugs, including evobrutinib, whose particular mechanism of action. By inhibiting the action of tyrosinchination in Bruton (Btk), acts both in modulating the responses of B lymphocytes and in modulating the activation of microgliathe cells responsible for the immune function of the nervous tissue that have the antigen that triggers the disease – he points out Francesco Patti, associate professor of Neurology at the University of Catania -. Making microglia inactive would mean helping to extinguish chronic inflammation at the level of the central nervous system and not just at the peripheral level. It has also been seen how these drugs reduce the volume of smoldering lesions, those lesions that, like embers under the ashes, hatch in the structures of the central nervous system. This determines less demyelination, axon damage and neurodegeneration and determines the possibility of reducing the PIRA phenomenon, that is progression independent of relapses. Given the peculiarity of the model of action, these drugs could be used in combination with others already in use, as happens in the treatments of polychemotherapy in which they are already exploited. for fundamental to keep an eye on the possible risks of hepatotoxicitytherefore put in place ad hoc surveillance systems.
Regenerative care
Much attention has been paid to regenerative or remyelinating therapies, that is, capable of reconstituting myelin, the sheath that covers the nerve fibers and is destroyed by the disease. the new frontier of therapeutic research in multiple sclerosis. Promising preliminary data on the feasibility of promoting remyelination with drugs that have the ability to reach the central nervous system and activate microglia cells – need Maria Pia Amato, professor of Neurology at the University of Florence and director of the neurological rehabilitation division at Careggi University Hospital and IRCCS Don Carlo Gnocchi Foundation in Florence and president of ECTRIMS -. Recently it highlighted a protein marker of oligodendrocytes (the cells that form myelin in the central nervous system) promising to identify the pathological characteristics of the microenvironment conducive to myelin regeneration and recovery of lesions.
Rehabilitation becomes hi-tech
Finally, the revision of the European guidelines for rehabilitation which is essential for the treatment path together with drugs. The goal is to create uniform indications for healthcare professionals – he concludes Giampaolo Brichetto, new president of RIMS, Rehabilitation in Multiple Sclerosis, the European company engaged in rehabilitation -. Among the main innovations there will be the integration of digital therapies and patient monitoring with sensors to understand the evolution of the disease; the inclusion of indications on where to do the rehabilitation between the clinic, home and hospital based on the effectiveness and the level of disability. In the future it will go more and more towards a holistic approach to rehabilitate not only the motor aspects, but also the cognitive ones and those related to the occupation of the person, so that he can improve or maintain working skills.
November 1, 2022 (change November 1, 2022 | 10:04 am)
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