International meeting highlights multiple sclerosis risks – Day 1
This week, Copenhagen is hosting the 29th meeting of ECTRIMS (European Committee for Treatment and Research in MS), the largest annual gathering of physicians and researchers specialized in MS. A special focus of the first day was some of the risks associated with MS. The following are some of the highlights from Day 1.
Family members not at high risk of developing MS
The risk of developing MS is influenced by genetic factors but the disease is not directly inherited the way true genetic diseases are. What is inherited is a slightly higher susceptibility for developing MS. An analysis of the Swedish MS registry has come up with new estimates for the risk of developing MS in family members of people with MS (Westerlind and colleagues. ECTRIMS 2013; abstract 57).
Overall, these risks were very low. As you might expect, the risk of developing MS is highest for an identical twin – about 16 times higher than for someone in the general population (this would translate to an absolute risk of about 1-2%). Other brothers and sisters had an 8-fold higher risk. For mothers with MS, the risk of their child developing MS was about five times higher than for someone in the general population. What should be kept in mind, however, is that these are the relative risks. The absolute risk of MS is only 1-2% for an identical twin, and less than 1% for other family members (including a child). There was no increased risk of MS for more distant relatives, such as grandparents or cousins.
The researchers concluded that the risk of developing MS for family members of people with MS is lower than previously estimated.
MS symptoms provide a clue to progression risk
People with clinically isolated syndrome (CIS) have some early warning signs of demyelination that indicate that they’re at risk of developing MS. Researchers have analysed a CIS database of about 2,000 people to see if there are factors that will predict who has a higher MS risk (Jokubaitis and colleagues. ECTRIMS 2013; abstract 59). A number of studies have shown that MS medications such as the interferons and Copaxone can delay the development of MS, so most people (69%) were taking an MS medication.
Over a three-year period, 15% of people had disability progression – a much lower rate that what has been seen in CIS studies. The people at highest risk of progression were those with worsening muscle weakness or stiffness. Treatment with an MS medication reduced the risk of disability progression by about 50-60% for the interferons, and by about 70% for Copaxone. However, these results should be interpreted with some caution. Long-term follow-ups of CIS studies (e.g. BENEFIT study of Betaseron, CHAMPS study of Avonex) have not shown that starting CIS treatment earlier will have an impact on long-term disability (Kappos and colleagues. Lancet Neurol 2009;8:987-997; Kinkel and colleagues. Arch Neurol 2012;69:183-190).
Higher risk of eye damage in blacks with MS
MS is viewed as a disease that primarily affects people of Northern European ancestry. But in recent years, there has been a greater appreciation of the impact of MS on people of other ethnicities.
Although MS has long been considered to be rare in blacks, some recent studies have suggested that MS may be even more common in African-Americans than in white Americans (Langer-Gould and colleagues. Neurology 2013;80:1734-1739). Of great concern is that MS appears to be especially severe and disabling in African-Americans (Kister and colleagues. Neurology 2010;75:217-223).
One problem area is vision. A U.S. study conducted eye examinations in people with MS of African and Caucasian descent and compared the results (Kimbrough and colleagues. ECTRIMS 2013; abstract 60). The likelihood of having eye symptoms (optic neuritis) was comparable in the two groups at the beginning. However, over the next year or two, among those with optic neuritis, the risk of vision loss was higher for African-Americans compared to white Americans. This indicates that the rate of retinal damage progresses more rapidly in African-Americans.
One major failing of MS research is that blacks are under-represented in clinical trials, so the impact of medications on reducing disease severity is not well established. Thus far, one study has suggested that Tysabri is effective in reducing relapses and MRI activity in blacks (Cree and colleagues. Arch Neurol 2011;68:464-468). A new study analysing data from the FREEDOMS II trial has now reported that Gilenya does reduce the frequency of relapses and inflammation on MRI (Khan and colleagues. ECTRIMS 2013; abstract P522). After receiving Gilenya, relapse frequency decreased 29% and about 90% had no new inflammatory lesions.
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