ACTRIMS Forum 2021: Pre-Conference Expert Perspective

Luc Truyen, MD, PhD

The ACTRIMS Forum 2021 will be held virtually this year on February 25–27, as a precaution to the ongoing global COVID-19 pandemic; however, the influx of research is still on display. In its 6th year running, the meeting remains committed to presenting a comprehensive educational program and cutting-edge science, with a number of notable symposiums and virtual events.

Themed "The Spectrum of Multiple Sclerosis (MS),” the CME-accredited meeting is led by President Jeffrey Cohen, MD, and Chairwoman Anne Cross, MD. More than 300 posters will be showcased during the meeting, including notable highlights such as the Kenneth P. Johnson Memorial Lecture and the National Multiple Sclerosis Society (NMSS) Barancik Award Presentation and Talk.

To gain an early perspective of how the conference may shake out, NeurologyLive reached out to Luc Truyen, MD, PhD, global head of Development and External Affairs-Neuroscience, Janssen Pharmaceutical. Truyen was proud to discuss some of the accomplishments and data his company will be presenting, as well as offer a greater outlook on some of the notable presentations and takeaways he’s looking forward to.

NeurologyLive: Of the abstracts that Janssen is set to present, which stick out to you the most?

Luc Truyen, PhD: The thing that sticks out to me most is not any single abstract. I wouldn’t want to upset any member of the team by picking favorites. But this collection of looking at fatigue from all different angles, including the consistency, frequency, and impact of it in patients with MS. It’s triangulated out through the real-world evidence approach and the study data itself. Fatigue is very important, and we need to pay attention to it.

We as innovators, but also prescribers, payers, etc., all need to take notice that this is something that’s very real for the patients and impacts their life quality disproportionately. The number that sticks out is that from the work productivity assessments, about half of the people that were interviewed said they missed workdays due to fatigue. Just think about where the disease hits, especially in young, economically productive adults. Now they have to stay home because of their disease and the fatigue associated. Overall, it’s not 1 thing specifically I’m looking forward to, just that it hangs well together as to what the impact of fatigue is.

Are there any other abstracts or symposiums from colleagues or researchers that you’re looking forward to?

First of all, I just want to comment on the fact that we’re having these conferences while we’re in the situations we’re in. That’s a testament to the ongoing commitment and productivity of everyone involved in this endeavor to address MS. From the patient, their families, the investigators, the innovator companies, academics, we all kept at it. As a global community, we’re learning that we can still deliver great impactful science data even during these times.

Of course, I always look forward to therapeutic innovations and where are they coming from. In this particular juncture, I will be looking at how we assess where the vaccines come in under this COVID environment. How do we adapt our treatment programs? Do we need to adapt them? If yes, how do we do that so that we thread the needle between continued management of the disease, but also allowing vaccines to be able to do their work? That is an aspect I look forward to hearing about.

I think this will impact treatment practice for the long and foreseeable future. It’s clear that we might end up with COVID as more of a flu-type scenario where we may have to track it over the years. But in general, that’s what I’m looking forward to. How is our community reacting to COVID, and how does it inform our treatment decisions moving forward?

Where has research in MS trended over the past few years? Do you feel as though those trends may stay consistent with this year’s event?

Well, I think there’s a trend that hasn’t had enough movement in it and that’s, ‘how do we stimulate regeneration?’ I think we’re getting good and efficient at addressing the inflammatory part. But the role of the oligodendrocytes, the precursor cells of it, how are they thriving or not thriving in this environment caused by this disease? How can we positively influence that so we can prevent the progression of disability? That, to me is the holy grail moving forward. I’ll definitely be focusing on any and all abstracts that relate to that. There is 1 point of difference between the other neuro communities and COVID: Do treatments affect the immune system? That’s where we have to be cognizant in that it may be different than for example, Parkinson disease or Alzheimer disease, where it is probably going to be less of an issue. We might actually learn more from how our immunology colleagues deal with this in their treatments.

How has our knowledge of the disease evolved over the past decade?

A couple of lines of thought here. The first is that the typical paradigm of sequential treatments with increasing strengths. This is a chronic disease that has been subverted by data that shows if you can hit it harder early, the better it is for long-term disability. That’s where I see a place for treatments like ponesimod who are stronger earlier in the treatment consideration. Of course, the prescribing physician and patient have to make their own decision, but that’s just 1 thing we’ve seen. Hit harder earlier to save more brain, so to speak.

The other thing I’ve noted, as with all diseases, is that there’s probably not 1 single form of MS, per se. I don’t think we have enough data on hand to start tailoring specific regimens for specific subsets in an emerging field where all is not created equal. For example, understanding why MS is more aggressive in children is something we need to take a look at.

Are there areas of research that need more attention?

As I mentioned previously, matching up our ability to significantly reduce the inflammatory attack with our ability to protect the oligodendrocytes and their ability to remyelinate. That, to me, is going to be the next thing we need to work on. Only then can we really affect the long-term course of the disease. We hope of course that it directly affects the primary progressive MS patient for which has limited treatment options.

That to me is where we should focus, as well as internally. How can we play there? It’s some of the same analogy I use in prostate cancer, where all of a sudden, the microenvironment became a very important thing to look at. We asked ourselves, what makes these tumor cells survive? Well, what makes the oligodendrocyte not survive? The next big thing we observe is how can we affect them.

Is there anything else that you’d like to mention?

We’re looking forward to seeing the reactions of the field to the work we’ve put out on fatigue. As I’ve said, to the way we’ve characterized it, both from within our own data, which showed the positive effect we can have on stabilizing fatigue, but also in the real world, where it’s more of a reality for these patients. I’m looking forward to the community’s reactions to that. And then of course, if ponesimod is approved, how it will affect treatment choices moving forward.

Transcript edited for clarity. For more coverage of ACTRIMS Forum 2021, click here.