Summit Aims to Accelerate Consensus on Optimal Multiple Sclerosis Treatment Strategies

Dr. Robert Bermel explains why global MS experts will gather in Cleveland in March

In a time of more treatment options than ever before for multiple sclerosis (MS), Cleveland Clinic will be hosting an international panel of experts to unite the MS community around management strategies and goals.

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The Cleveland Clinic Neurological Institute Summit 2018: MS Treatment Strategies will take place March 22-24, 2018, in Cleveland. Although on-site attendance is by invitation only, the summit will be streamed live on Friday, March 23, for remote attendance and will be available for CME credit. Remote attendees will be able to submit questions and comments during the sessions.

The summit will be co-hosted by Robert Bermel, MD, Director of Cleveland Clinic’s Mellen Center for MS Treatment and Research, and Jeffrey Cohen, MD, Director of the Mellen Center’s Experimental Therapeutics Program. Dr. Bermel recently fielded a few questions about the event.

Q: What will the MS Treatment Strategies summit involve, and what’s the impetus for it?

A: We’re gathering leading international experts in all aspects of MS diagnosis and treatment to discuss the current landscape and develop optimal management practices as well as strategies for moving the field forward. Current treatments are being used in new ways, and novel treatments are rapidly coming aboard, giving practitioners greater flexibility in managing patients.

The field of MS is at a critical juncture. The traditional way of treating patients has been a conservative approach of escalation: After diagnosis, patients are started on the safest but weakest drugs in a trial-and-error fashion to control symptoms. As the disease progresses, increasingly potent and potentially riskier drugs are tried.

The new paradigm — known as highly effective early treatment, or HEET — treats patients with the most powerful drugs early in the disease course. This “flipping the pyramid” model is a strategy increasingly used in rheumatology to treat autoimmune diseases. It has been known for some time that early treatment is better than late treatment for MS; the logical extension is that early effective treatment is better than late effective treatment.

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Which strategy is better? Clinical data haven’t yet been able to define the optimum use of the available new treatment options. Two very important studies, one coordinated at Cleveland Clinic, are starting to address this very question. The summit’s goal is to consider existing research and clinical trial data as well as expert opinion to come to a consensus on optimal management and summarize our recommendations in a white paper to be published soon afterward.

Q: How will the summit differ from other MS conferences?

A: This series of MS conferences hosted by Cleveland Clinic — the first two took place in 2012 and 2013 — is unique. Typically, CME meetings are designed to bring providers up to the current standard of care. These summits are instead gatherings of international experts with the aim of coming to a consensus on best practices and determining future directions.

Although professional societies provide guidance on clinical management, it typically takes years to thoroughly review the literature and reach a consensus. In this field of rapid change, by the time the guidelines are released, they are often out of date. Our aim is to be a bit more agile by determining what worldwide experts can agree on today regarding treatment strategies and provide that information promptly to doctors in practice.

Q: The summit agenda reveals a faculty that includes authors of some of the most important recent papers in MS. Are there particular highlights?

A: There are many, but I’ll mention just a few.

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Cleveland Clinic’s Daniel Ontaneda, MD, and Ellen Mowry, MD, from Johns Hopkins University, will update us on two independent multicenter studies funded by the Patient-Centered Outcomes Research Institute (PCORI), which are directly comparing the strategies of escalation versus HEET for managing MS. The idea behind these studies, including the Cleveland Clinic-led $10.6 million international randomized trial, initially arose from discussions during the earlier Cleveland Clinic MS summits.

An “out of the box” keynote address will be provided by Jack Po, MD, PhD, of Google’s DeepMind, who will help us understand the potential application of artificial intelligence and data analytics to drive best treatment practices. MS, with its complex diagnostic classification system, variable prognosis and multiple treatment options, presents particular challenges for determining best practices. New advances in the field of complex data management may provide important tools for overcoming those challenges.

Additionally, Scott Spradlin, MD, Chief Medical Officer of Aetna, will present a payer’s perspective on the need for consensus in MS management. Anyone who has been forced to determine patient management based on what treatment insurance will cover — and that’s probably all of us — knows the importance of bringing this key stakeholder into the discussion.

For more information on the MS Treatment Strategies Summit and to register for the March 23 live stream, visit clevelandclinicmeded.com/live/courses/ni-summit-ms/.