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Introduction
A Year in Neurology
a report by
Patrick Wong, PhD
Senior Medical Editor, Touch Briefings
The growing attention on the burden of neurological disorders continued As all currently approved MS medications are available only as injectable
in 2008, with the European Brain Council launching the first formulations, there has been much interest oral agents and positive
multidisciplinary forum on major brain disease, with a special focus on results from clinical trials have been reported this year for the following:
Parkinson’s disease (PD). There is increasing recognition that greater vitamin D
3
, rolipram, ibudilast (MN-166, Avigen), laquinimod (Teva
resources and co-ordinated research strategies are required to tackle the Pharmaceutical Industries and Active Biotech), cladribine (Leustatin
®
,
major neurological disorders. In the interim, data presented at Merck Serono), fingolimod (FTY720, NovartisPharma), and BG-12
international professional society meetings continue to add to the (dimethyl fumarate, Biogen Idec).
growing knowledge of disease pathology across several disciplines.
Alzheimer’s Disease
Multiple Sclerosis Researchers who evaluated the consumption of fish and the
In multiple sclerosis (MS), 2008 has been a big year in terms of disease- appearance of lesions in the brain scans of 3,660 people 65 years of
modifying therapies. Results from key clinical trials presented at the age and over have found that a diet of broiled or baked tuna and other
60th annual meeting of the American Academy of Neurology (AAN) fish high in omega-3 fatty acids three times or more each week can
revealed that high-dose interferon beta-1b (Betaferon
®
/Betaseron
®
, reduce the appearance of the lesions that can cause dementia and
Bayer Schering Pharma) had little advantage in efficacy over its low- stroke by nearly 26% compared with those who did not. This benefit
dose counterpart, and no clear superior efficacy could be discerned was not seen with a regular diet of fried fish.
between interferon beta-1b or glatiramer acetate (Copaxone
®
, Teva
Pharmaceuticals). Nor have any greater clinical benefits been found by Definite diagnosis of Alzheimer’s disease (AD) is only possible post mortem,
doubling the standard dose of glatiramer acetate. Significantly, very and the current methods of diagnosis via brain scans, blood tests, and
strong evidence has been presented in support of early treatment with interviews hold an accuracy of about 85%. However, researchers have
interferons and glatiramer acetate immediately following the initial MS shown that computers can be programmed to distinguish the scans of
attack. This strategy has been proposed as potentially delaying patients with AD from those of healthy individuals and patients with other
progression to clinically definite MS. forms of dementia with an accuracy as high as 96%—an attractive option
in terms of cost- and time-efficiency.
Also presented at the AAN meeting were updates on new and current
therapeutics. The anti-CD52 monoclonal antibody alemtuzumab Regarding risk factors, a maternal history of AD has been found to confer a
(Campath
®
, Genzyme/Bayer Schering Pharma) has been under investigation predisposition to impaired glucose metabolism in regions of the brain that
for the treatment of relapsing–remitting MS (RRMS). At three years, are associated with the disease. The likelihood of developing AD differs
alemtuzumab was associated with significant reductions in relapse rate between the sexes, with one in six women and one in 10 men at risk, but
(73%) and risk for sustained accumulation of disability (71%) compared studies have recently reported that there are critical sex-based risk factors in
with the interferon beta-1a comparator; clinical trials continue that will help the progression from mild cognitive impairment to dementia: depression in
to define the role of alemtuzumab in RRMS. Positive results have also been women and stroke in men. Observational studies and primary prevention
reported for daclizumab (Zenapax
®
, Biogen Idec) and rituximab trials suggest that antihypertensive treatment can reduce the risk for AD.
(Rituxan
®
/Mabthera
®
, Genentech/Biogen Idec/Roche). Natalizumab
(Tysabri
®
, Biogen Idec/Élan), approved for monotherapy in MS patients who Various trial results presented at the Alzheimer’s Association International
were unresponsive to or intolerant of alternate MS therapies, has been Conference on Alzheimer’s Disease (ICAD) 2008 present new potential
associated with an increased risk for progressive multifocal future therapies. Levels of an intravenously administered experimental
leukoencephalopathy (PML). With more than 40,000 natalizumab- monoclonal antibody LY2062430 that targets amyloid-β (Aβ) were found
experienced patients and no cases of PML, there was hope that the previous to be increased in the cerebrospinal fluid (CSF) of patients with AD,
cases were due to interaction with concomitant therapies, controllable by leading scientists in this phase IIb study to believe that this is due to a
natalizumab monotherapy. Sadly, two cases of PML have emerged this year dissolution of brain plaques by the antibody. Researchers have also
in patients receiving natalizumab monotherapy for approximately 14 and 17 proposed a role for the antihistamine dimebon in sustaining clinical benefit
months. While the current indication for natalizumab remains unchanged, in mild to moderate AD; dimebon is believed to work by preserving
physicians are urged to be extra vigilant about any adverse effects observed. mitochondrial function, which may have a neuroprotective effect. The six-
4 © TOUCH BRIEFINGS 2008
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