Martin Weber: Unmet Needs in MS and What We've Learned from NFL

At MS Paris 2017, MD Magazine sat with experts and key opinion leaders in the treatment of multiple sclerosis (MS) to discuss the important and innovative topics from the conference.

Martin Weber, MD, an associate professor of neurology at the University of Göttingen in Germany, discussed what clinical needs are still not being met in the treatment of multiple sclerosis, as well as how much we have learned from looking at neurofilament and other biomarkers.

Weber noted that while much has been learned in the past few years, we are still in the infancy of understanding the later stages of the neurodegenerative disease and that if progress is going to continue to be made, we must focus on finding additional biomarkers and drugs that have neuroprotective effects.

Martin Weber, MD, an associate professor of neurology at the University of Göttingen:

The biggest unmet need, clearly, is drugs that are acting on the central nervous system (CNS) itself. I think we became very efficient in treating the immune system, and preventing relapses, and preventing lesion formation. I think that's that's a really chief goal, so to say, but I think the continuous process in the CNS, for both inflammation and degeneration, is only partly dependent on this de novo infiltration.

That's a process where we are only starting to understand—which is probably really relevant for disability due to atrophy—for the hard outcomes, so to say, in patients. These probably can only be influenced by identifying and targeting crucial steps within the central nervous system, probably involving microglia, and astrocytes. [These are] new players of CNS resident cells where there is basically no evidence that any of the established MS drugs are affecting these cells at all.

Now, something that gets attention, which I probably would have answered 2 years ago, which is I think very important, is degenerative measures in MS. Meaning neurofilament is probably one of the most important biomarkers for a patient because it is ultimately the one biomarker that is showing you how much CNS, or let's say how much axons, are lost. Meaning that either that's by lesion information or that's by chronic degeneration of NFL. The neurofilament being high is not a good thing, and so for the first time, we have now a measurement of this degenerative process within the central nervous system. We are only starting to understand that the drugs that we have are only partially influencing this process.

Two years ago I would have said exactly that's the marker that everybody needs to go after, and that's fortunately what happened. Right now I don't see that need yet, maybe throughout the conference, we will identifying the next one.