MS Wrap-up: Ancestral Ties to MS Prevalence, S1P Therapy Advances, and More

Here are some of the latest developments in multiple sclerosis (MS) from our sister publication, NeurologyLive®.

Does Ancestry Impact MS Prevalence?

New research assessed the occurrence of MS and neuromyelitis optica spectrum disorder (NMOSD) among indigenous populations in New Zealand and Australia. Although results showed the Māori indigenous population in New Zealand had higher rates of NMOSD, MS was intermediate between those living in New Zealand with Southeast Asian and European ancestry. Both conditions appeared to be uncommon in Australia’s indigenous populations.

“One advantage of our comparison of ethnic ancestry between NMOSD, suspected NMOSD, and MS is that the process of case ascertainment and data collection was the same for all 3 groups,” researchers explained.

“There was also good consistency between our clinically collected MS cohort and the previously collected ethnic ancestry specific prevalence data. The relative prevalence in those of Asian ancestry was 1% of the overall European MS prevalence,” they said.

Reviewing S1P Oral Medications

A presentation at the virtual Institutional Perspectives in Neurology: Multiple Sclerosis program focused on the latest approved therapies in the sphingosine phosphate 1 (S1P) targeting class of oral medications for MS.

The talk, given by Jessica L. Stulc, MD, MPH, the director of the Multiple Sclerosis Treatment and Research Center at the Minneapolis Clinic of Neurology, discussed the mechanisms of action for the new entries in the S1P class, ozanimod (Zeposia; BMS) and ponesimod (Ponvory; Janssen). These drugs were approved in March 2020 and March 2021, respectively.

“These are G protein couple receptors that work as a signaling molecule. Primarily, for MS, the function we’re aware of is that it keeps the lymphocytes in the lymph nodes—you have to have signaling to allow egress of the lymphocytes out into the peripheral tissues,” Stulc said.

She noted drug sequencing, timing and mechanisms of action should all be taken into consideration is providers choose to recommend these medications.

Fumarates for Relapsing MS

In a NeurologyLive® peer exchange, experts discussed considerations for the use of fumarates among patients with relapsing MS.

Fumarates as a class were first introduced in the United States around 2011 and 2012, explained Ravi Dukkipati, MD. “Initially there was dimethyl fumarate, and then there was a newer iteration of dimethyl fumarate, diroximel fumarate. These have established themselves quite well, in the United States and internationally, as a viable oral option for patients with relapsing remitting MS,” he said.

However, compared with several S1Ps and B-cell depleters, Dukkipati would characterize their efficacy as modest. “The one concern with the fumarates has been tolerability, namely GI [gastrointestinal] and flushing,” he added.

In addition, individuals who take these drugs do report multiple adverse effects, and will tend to stay on the medication for about 2 years, said Lauren Gluck, MD.