Day One.
Webinar Chairman Dr. Mustafa Shakra, Neurology Consultant at Sheikh Khalifa Medical City, has officially welcomed everyone to the Abu Dhabi congress, which he addressed as ‘yearly successful landmark event’. Dr. Mustafa has expressed his sincere appreciation to all who generously helped to make the event a success. According to him, the primary objective of the event is to let the people be in direct contact with experienced neurologists in the field of Multiple Sclerosis while they deliver high quality and most updated knowledge.
Dr. Abubaker AL Madani, Senior consultant and Head of Neurology department at Rashid Hospital, has begun the webinar session. He emphasized the topic of “Biomarkers to predict Multiple Sclerosis”. He pushed the significance of more precise biomarkers for individualized treatment for MS patients. Amid the session, Dr. Madani has talked about the Hereditary & Immunogenetic Biomarkers and assessed laboratory Biomarkers for MS.
Dr. Manzoor Ahmed, Consultant Neuro-Radiologist of Sheikh Khalifa Medical City, UAE on the topic of “Neuro-imaging of NMOSD – MRI Update”, has presented a very detailed presentation in which 3 major Demyelinating Disorders such as Negative Serology (NMO & MOG), Positive Serology (NMO/anti-AQP-4 Ab), and Positive Serology (anti-MOG-antibody) with 90% of female patients are likely diagnosed with Optic Neuritis and cerebral lesions under NMO-related Demyelination. In summary of his well-thought discussion, Dr. Manzoor Ahmed has put emphasis on Correlative Clinical Characteristics of NMOSD on MRI as a crucial role in the treatment of MS.
For a MERK symposium on the subject of “Getting Closer to Life without MS”, Dr. Mona Thakre, Consultant Neurologist of Al Zahra Hospital Dubai, shared a sample of 88 patients under the treatment of Mavenclad, indicated for the treatment of adults with ‘highly active RMS as defined by clinical or imaging features. It is also studied that Mavenclad has one of the largest 10 collections of clinical experience prior to launch of any high-efficacy DMD in RMS with phase III studies and an 8-year safety registry. On the other hand, Dr. Jihad Said Salim Inshasi, Consultant Neurologist and Professor of Neurology Rashid Hospital, acknowledged some inquiries particularly on the question for COVID vaccinations for MS patients who can start Mavenclad between 6-8 weeks.
Under the umbrella of Novartis, the symposium on “Updates in MS B-Cell Therapies” was discussed by Dr. Derk W. Krieger, Professor of Neurology, Chairman of the Neuroscience Center, Mediclinic Dubai Campus, in which in summary the disposition to MS and its clinical course is determined by genetic and environmental factors. Immune response is tightly controlled and can be swayed by interfering with innate and adaptive mechanisms; Initially MS is mediated by T-cells, however, there is a tight B-T cell interaction; B-cell depletion reduces disease activity and recurrence. His discussion on current MS therapies and their targets was clearly revelatory in which he argues that medications such as Fingolimod and Cladribine works inside the brain and some are affecting the peripheral immune system. Thus, as concluded, ASCLEPIOS I and II studies in a broad RMS population successfully demonstrated that Ofatumumab (vs teriflunomide) showed: superior efficacy in lowering relapse rates and MRI activity; Substantial and significant reduction in 3-and 6-month CDW; Lower levels of Nfl already at month 3 and at all subsequent visits; A favorable safety profile with no unexpected safety signals. There was no imbalance in the rates of infections or malignancies (low on both arms), and featured Ofatumumab with monthly 20 mg s.c.* dosing regimen, demonstrated high efficacy and a favorable safety profile.
The virtual congress continues with Dr. Beatrice Beneditti, Staff Physician, MS Specialist, and Neurological Institute of Cleveland Clinic Abu Dhabi Hospital, on the topic of “Highly Efficacy DMTs in MS”. She started in full details specifically on the treatment approach paradigm in MS and how aggressively should we treat MS. The Highly Efficacy DMTs for medications such as: Natalizumab, Ocrelizumab, Ofatumumab, Alemtuzumab, and Cladribibe have higher efficacy in decreasing MR activity and relapse; Possible effect in preventing/delaying long term disability, whereas as a side-effect can increase risk of infection, risk of cancer, and autoimmune disease. As a rationale, MS is characterized by an overlap of inflammation and neurodegenetation, and the inflammatory component is more active early. She also concluded that the choice of DMT represents a crucial moment in MS management and Highly-efficacy DMTs can be used in the setting of an “escalation approach” which focuses on safety, or “highly-effective treatment early approach” (induction) which prioritizes efficacy.
Dr. Mustafa Shakra himself has given us a presentation on “NMOSD: An Updated Review” in which by a general definition across medicinal literatures, Neuromyelitis Optica Spectrum Disorders are inflammatory disorders of the central nervous system characterized by severe, immune-mediated demyelination and axonal damage predominantly targeting optic nerves and spinal cord. As for attacking prevention, Dr. Shakra suggested that treatment is recommended with eculizumab, inebilizumab, satralizumab, where available, rather than other immunosuppressive agents for patients with AQP4 An seropositive NMOSD. And treatment of NMOSD with interferon beta, natalizumab, or fingolimod is not effective and may be harmful. As a preventive precaution, he also warned of making the diagnosis exclusively based on serology which requires compatible symptoms/MRU findings and of false positive NMO-IgG, especially when there are clinical concerns about the diagnosis; confirm with cell-based assay.
For Sanofi symposium under the title of “The Use of Alemtuzumab in Patients with Relapsing-remitting Multiple Sclerosis: The Gulf Perspective”, Dr. Raed Alroughani, Consultant Neurologist, Director of MS Clinic, Kuwait City, presented the discussion with such clarity in which the real world evidence has become increasingly used to show the effectiveness of DMTs in clinical practice; Observational studies are valuable to longitudinally assess the safety data. Alemtuzumab continues to show similar effectiveness to what was shown in pivotal trials and Risk management plan is easy to implement after effective patient’s education. Despite its high efficacy and well-known risk/benefit profile, alemtuzumab is yet to be fully utilized in the Middle East for patients with RRMS. He also presented conclusion of Gulf Consensus in which a patient profile identified carefully by experts in MS care provided key indicators that can help physicians develop an informed treatment decision. Patients who are of a younger age, treatment naïve, with highly active disease and short disease duration, of child-bearing potential, and at high risk of developing disability can achieve better outcomes with alemtuzumab.
In its entirety, the first day conference of the 3rd Abu Dhabi Multiple Sclerosis Webinar was full of new insights, complemented as well with question and answer in each session to keep the virtual floor exciting with speakers profound knowledge to provide us the most recent and comprehensive discussion about Multiple Sclerosis.
Day Two.
With the success of the 3rd Abu Dhabi Multiple Sclerosis Webinar held on November 21, 2020, the virtual conference on Multiple Sclerosis continues on its second day-journey, garnering a total of 1026+ attendees, and managed by Medetarian Conferences Organizing (MCO), the leading healthcare events coordinator in the UAE.
The second-day webinar session conducted on November 22, 2020, was still chaired by Dr. Mustafa Shakra, Neurology Consultant of Sheikh Khalifa Medical City. Commencing on his speech by welcoming speakers and participating delegates all over the world, Dr. Mustafa Sharkra addressed, “Abu Dhabi Multiple Sclerosis Webinar is a yearly successful landmark event that is precisely highlighting the hottest topic in the field of MS disease. The aim of this congress was always to let you be in direct contact with experienced Neurologists in the field of Neurology”.
Dr. Aref Al Shehi, Chief Executive Officer, Medical Director of Abu Dhabi Rehabilitation Center Sheikh Khalifa Medical City, presented the topic on “When Patient with Multiple Sclerosis Gets Old”. In his objectives toincrease attention and awareness, he highlighted that MS is one of the costliest illnesses to treat with an age peak of diagnosis between 20 to 40 years. The discussion included a relevant diagnosis of MS specifically on the clinical side in which MRI is very much recommended for diagnostic evaluation for patients manifesting symptoms such as Sensory disturbance, Sensory disturbance, Pain, Fatigue, Depression, Cognitive dysfunction, Ophthalmologic dysfunction, Cerebellar dysfunction, Motor and spasticity, Bladder dysfunction, Bowel dysfunction, Heat intolerance, and Swallows dysfunction. According to Dr. Aref Al Shehi, old patients with MS will likely to experience the cardiac disease when doing strenuous physical activity.
On the subject of “Why Timing is Crucial with Ocrelizumab”, a drug for the treatment of multiple sclerosis, Dr. Deeb Kayed, Consultant Neurologist of Mediclinic City Hospital, demonstrated a case of a 35-year-old Irish patient who started theOcrelizumab treatment on April 2009 but it led to a serious series of consultations due to liver lesion detected from an MRI on October 2009. Dr. Deeb Kayed also discussed in a visual presentation as to why Ocrelizumab reduced ARR through 6-years of treatment from a pooled analysis of Opera 1 and Opera 11.
Dr. Areen Said, Neurologist of American Hospital, discussed “Primary Progressive MS: The Mimics”, in which she demonstrated 10 in-depth diverse cases of MS which she also later concluded that Primary Progressive MS can be diagnosed in patients with 1 year of disability progression.
Going further through the flow of the conference, Dr. Victoria Ann Mifsud, Staff Physician of Neurological Institute Cleveland Clinic Abu Dhabi Hospital on “Women and MS” explained that MS is more common in women with hormonal factors such as immunostimulatory at low levels for a biphasic dose-effect on Oestrogens. Moreso, Dr. Mifsud also deliberated the significant time in which Education and Counseling for Disease-Modifying Therapy (DMT), as an option to think ahead to choose pregnancy compatible DMT when possible and discuss the likely pre-conception plan for DMTs so that patient knows what to expect. Medication-wise, Natalizumab, a drug used to treat multiple sclerosis, and Crohn’s disease does not cross the placenta in 1st trimester. She also argued that women with MS should be encouraged to breastfeed whenever possible.
Dr. Derk W. Krieger, Ph.D., Professor of Neurology and Chairman of the Neuroscience Center Mediclinic Dubai Campus, shared the topic on “TYSABRI, The Power You Need the Experience You Trust for Your Highly Active Relapsing-Remitting Multiple Sclerosis (RRMS) Patients”. In his presentation, he confirmed the efficacy and safety observed in real-world patients taking Tysabri. This type of medication also collects data on safety and clinical outcomes in those patients initiating TYSABRI treatment in clinical practice. He also later discussed the evolving benefit-risk data forNatalizumab in which the efficacy of Natalizumab EID after year SID is being investigated in the NOVA trial. New data also confirm TYSABRI’s safety profile and sustained disease control in real-life patients.
On the symposium for Aspen, Dr. Ahmed Shatila, Consultant Neurologist of Sheikh Shakbout Medical City, presented a very interesting topic on “The Clinical Value of Glatiramer Acetate”. As defined, Galtipex is indicated for the treatment of relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome (CIS), and relapsing-remitting disease (RRMS). And as a summarized conclusion, the efficacy and safety of GTR are maintained over 2 years while Glatiramer Acetate (GA) is an established treatment option for newly diagnosed MS patients that delivers proven efficacy combined with optimal safety and low treatment burden.
As averred by Mustafa Shakra, one of the hottest topics in the entire congress was the “Stem Cell Transplantation in MS” discussed elaborately by Dr. Ruqqia Mir, Consultant Neurologist of Sheikh Khalifa Medical City in which she highlighted the simple goal of HSCT as a selective re-programming or “reboot” the adaptive immune system. Several trials on MS were also cited as relevant clinical cases on patients with severe MS supported as well with recent studies in Stem Transplantation.
According to an article published by NeurologyLive.com, a research update in which a small, preliminary study in JAMA has found that hematopoetic stem cell transplant (HSCT) may be more effective than disease-modifying drugs in patients with highly active relapsing-remitting multiple sclerosis (MS).1 The study is the first randomized trial of HSCT in relapsing-remitting MS. (https://www.neurologylive.com/view/progress-stem-cell-transplant-ms)
Complementing these medical studies, Dr. Ruqqia Mir expanded her investigative research based on the treatments of participant’s quality of life with MS.
Dr. Suzan Ibrahim Noori, Senior Consultant Neurologist and Associate Professor Medical College of University Hospital Sharjah has aimed to shed light on the topic of “Radiological Isolated Syndrome (RIS)” which was designed to capture individuals that are having MRI scans before for reasons other than evaluation of MS. She also explained that there are therapeutic trials in RIS as technology advances in the recognition of this disease. In a conclusion, RIS is an entity that requires much better characterization. *More studies are also needed with advanced MR imaging techniques to investigate whether novel technologies being developed will help identify which patients with RIS are at greatest risk for conversion to clinically definite MS.
Dr. Mustafa Shakra, on a final note, congratulated everyone for being a part of this congress and looking forward to the 4th Abu Dhabi Multiple Sclerosis Webinar to be held on 11th September 2021. Save the date!