Aaron Boster: Changing Dogma and Long-Term Data in MS

DECEMBER 06, 2017
Matt Hoffman
At MS Paris 2017, MD Magazine sat with experts and key opinion leaders in the treatment of multiple sclerosis (MS) to discuss the important and innovative topics from the conference.

Aaron Boster, MD, the systems medical chief of neuroimmunology at OhioHealth, in Columbus, discussed some of the things that excited him from the 7th annual joint ECTRIMS-ACTRIMS conference.

First, the change in dogma related to how and when MS is diagnosed, which greatly impacts the physician's ability to treat patients sooner and more effectively. Second, he expressed excitement about the long-term data that has been collected recently that now allows physicians to show their patients expected outcomes for years down the line.

Aaron Boster, MD:
There are 2 things that I'm really excited about that I'd like to talk about briefly. One is, yesterday, I sat in the audience and watched us change dogma. We have now heard the recommendations for the 2017 revision of the McDonald Criteria. What I'm saying is, we've redefined how we diagnose multiple sclerosis.

As you look at the diagnostic criteria going back from the 1980s and forward, we have become faster, and faster, and faster. Moving from 2010 to 2017 criteria, we have done that yet again. By reintroducing the use of spinal fluid early on, with clinically isolated syndrome (CIS), we can confirm an MS diagnosis much faster. This is very important because the quicker we can make the diagnosis, the faster we can initiate disease-modifying therapy. The data is outstanding, proving the point that the earlier, the better. That was very exciting, to participate in that audience. 

I'm also very excited about some of the long-term follow-up data. When you do a 2-year clinical trial, it is a very short hypoc. MS is measured by decades, and the person is going to live with the condition for 30 to 40 years. As such, a 2-year investigation may be fully inadequate to really have a meaningful conversation in the real world about "what do we expect?"

Some of the posters that I've participated on looked at alemtuzumab, and the 7-year long follow-up data, and it is amazing. Really, in a nutshell, what we are seeing is that going out 7 years, even though over half of patients never got re-treated, there is a durable effect. We are seeing a maintenance of a very, very low annualized relapse rate. Confirmed disability progression diminishes and stays remarkably low. MRI measures, including atrophy, and inflammatory measures remain amazingly low despite re-treatment. Most importantly the side effect profiles are not changing. Having that information at hand, I can now go back to Columbus, Ohio, and treat people and share with them our expectations now going out 7 years. That is really meaningful.

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