The future of MS biomarkers: key takeaways from ACTRIMS 2022

By Peter Ngum, Clinical Application Specialist

The seventh annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2022 took place in sunny West Palm Beach, Florida. Over the three days of February 24-26, the ACTRIMS forum brought together 1500+ in-person and virtual participants. The conference highlighted novel scientific discoveries for multiple sclerosis (MS), focusing on MS biomarkers. I attended numerous informative sessions where I learned more about the role of various biomarkers in MS diagnosis and management as well as innovative developments in the field.

Here, I describe my main takeaways from the event.

The state of MS biomarkers — there is room for improvement.

Biomarkers play an integral role in MS diagnosis and management decisions; however, current MS biomarkers used in clinical practice are not sufficiently specific. We learned about ongoing cutting-edge research on diagnostic, prognostic, and predictive MS biomarkers, including paramagnetic rim lesions, central vein sign, cortical lesion burden, and neurofilament light levels.

More, and better, treatments are becoming available.

There has been a remarkable increase in disease-modifying therapies available to manage MS. This, in addition to several cutting-edge ongoing studies that hope to introduce novel measures to capture and treat disease activity, provides renewed hope for MS patients, notably, the use of phenotypes of bone-marrow-derived and CNS resident myeloid cells as targets in MS; a tyrosine kinase inhibitor that has previously shown effectiveness in preclinical models of MS; and and a real-world study that confirmed the safety of ocrelizumab in two different MS populations in Spain.

MS is an economic burden for the United States.

My next key takeaway was the enormous economic burden of MS in the United States. According to findings presented by researchers from the National MS Society in Washington DC and the MS Center of Excellence in Baltimore, the burden of MS in the United States in 2019 alone was over $85 billion, with a direct medical cost of over $63 billion. The study further showed that not all patients with MS are treated with disease-modifying therapy.

Many MS patients remain untreated.

Interestingly, despite the multitude of disease-modifying therapies and the numerous ongoing groundbreaking studies, half of insured patients with MS remain untreated. It remains unknown precisely why such a high proportion of patients go untreated. The non-specific clinical presentation of MS in the early stage could be one explanation. For already diagnosed patients, comorbid conditions, long wait times to see a neurologist, and being diagnosed with milder forms of MS, are other reasons believed to be responsible for not receiving treatment.

Nevertheless, most researchers and clinicians believe that treatment for MS should be based on a personalized approach determined by the patient’s specific clinical parameters, disease prognosis, and treatment risk. To achieve this, and central to the theme of ACTRIMS 2022, biomarkers that can predict disability, monitor ongoing disease activity, and assess treatment response are integral in making critical clinical decisions for MS treatment.

Enhanced neuroimaging is possible with AI.

Although genetic markers and body fluids were among the biomarkers presented at the 2022 ACTRIMS forum, enhancing neuroimaging with artificial intelligence (AI) was of particular interest to me because of the meaningful difference it can make in the lives of patients with MS, augmenting current imaging standards and improving diagnostic accuracy.

In clinical practice, magnetic resonance imaging (MRI) plays a crucial role in diagnosing, monitoring, and predicting outcomes. Lesions identified on MRI are used as biomarkers for MS diagnosis and treatment planning. The NAIMS Symposium on Imaging Chronic Active White Matter Lesions reviewed the current understanding of chronic active lesions (CAL) in MS. The workshop further explored the role of CAL in monitoring disease progression. Of particular interest was using paramagnetic rim lesions to gauge MS clinical severity.

Besides paramagnetic rim lesions, other T2-hyperintense lesions are more commonly used in clinical practice to diagnose MS. Detecting these lesions is an arduous, time-consuming task and depends on the physician’s experience level. Fortunately, in line with presentations at ACTRIMS, advances in AI have demonstrated the ability of automated computer-aided solutions to facilitate early diagnosis and monitoring of disease progression in MS. Computer-aided, AI-enabled applications play a crucial role in diagnosing MS by identifying radiographic characteristics such as paramagnetic rims and other white matter hyperintensities that may otherwise go unnoticed by a physician.

MRI images and other acquired patient data can be automatically analyzed to provide objective and quantitative information on lesion count, size, and change over time. While it has long been possible to quantify and standardize these characteristics in larger patient groups, it is also currently possible to do this with individual patients in clinical practice.

One such solution that makes this possible is the cloud-based, AI-powered, neuroimaging solution developed by Combinostics. Our automated image analysis tool, cMRI™, improves MS diagnostic workup standards by removing subjectivity and providing quantitative information to drive better clinical care and outcomes for MS patients.

ACTRIMS 2022 provided an opportunity for me to learn about cutting-edge research in MS, network with researchers, and discuss advances in research. The advances in research are plenty, and the future of MS looks promising.

Next, I’m looking forward to attending the AAN 2022 Annual Meeting. Will you be there? Schedule some time to chat about what you’re finding of interest in neurology.