Carlo Pincelli opened the first session of the Symposium with a comprehensive presentation on the history of psoriasis starting from the 10th century BC to last decades of the 20th century. Brilliant intuitions, mistakes and serendipity tracked the path of knowledge, but it is clear that this disease has accompanied mankind since the beginning of time. From the past to a more updated method to evaluate the efficacy of treatment, Harry Beitner presented a review of the evidence-based data available for the traditional systemic treatments used in moderate to severe psoriasis. This speaker pointed out that most of the available data on ciclosporin has been collected with the old formulation and is not reproducible for the current one and that doses higher than 5 mg/kg/d do not provide additional therapeutic advantages in comparison to lower doses. Other treatments were presented with the same accuracy, from methotrexate to retinoids and PUVA. Knud Kragballe’s lecture was the ideal continuation of the previous one because he introduced the limitations of traditional therapies and pointed out the unmet needs of those approaches. The speaker showed the results of the Europso psoriasis patient study that collected the reports of 17,990 members of European psoriasis associations quantifing patient satisfaction and problems related to treatment as perceived by patients. That data confirmed that there is room for improvement with traditional therapies in efficacy, in access to treatment, clearance of lesions, toxicity of therapies, convenience and management of monitoring.
Wayne Gulliver was next starting his outstanding lecture with the same concept: the impact on life of psoriasis and the needs of patients must be the top priority for physicians. He defined the management of this disease a “challenge” and proposed a list of factors that influence the treatment choice, but underlined that in psoriasis the therapy must be “patient centred”. One of the most important targets is the continuous control of the disease and, as an example, he showed the results obtained in a five years maintenance study with a biologic. Helen Richards, a clinical psychologist with an extended experience in psoriasis management, expanded the topic of the psychological impact of this disease showing data on adherence to treatment that clearly illustrated how supporting patients could be markedly improved. She completed her presentation showing how this support can be provided. Nikhil Yawalkar instead tackled the complex topic of the immunological bases of psoriasis showing impressive images. He guided the audience through hypothesis and available certainties on these mechanisms. Christopher Griffiths closed the first session of the Symposium by proposing, in a provocative way, the concept of “ideal treatment” of psoriasis. His elegant presentation started from the variables that should be considered in order to evaluate treatments and tried to depict a mosaic were each one of the available treatments could find the right place.
The second session was entirely dedicated to the new therapies that have changed the management of this disease. Sergio Chimenti presented the biological activities of TNFalpha and mechanisms of action of TNFalpha-blockers used in psoriasis. Furthermore, he showed the results collected in his center with these kinds of drugs. Alexander Stratigos spoke about Alefacept and Efalizumab, the other two biologics indicated in psoriasis. The speaker defined both molecules as “T-cell modulators” and marked the differences in their mechanisms of action. Alefacept blocks interaction between antigen presenting cells and CD-2 on T-cells, inhibiting the activation of the latter. The induction of apoptosis of CD4+ and CD8+ memory T-cells is the other effect attributed to the molecule. Efalizumab blocks the adhesion of CD11 to ICAM-1, thus inhibiting key mechanisms of the pathogenesis of psoriasis such as T-cell activation, T-cell trafficking towards dermis and epidermis as well as T-cell reactivation in skin. The speaker also showed the results of studies that confirmed the effects of efalizumab on T-cell kinetics and functions.
Hervé Bachelez’s continued the session by speaking about the safety of biologics. The major side effects observed both in psoriasis treatment and in other indications with TNFa-blockers were reviewed from the more severe, such as tuberculosis, to milder effects. The safety profile of efalizumab was presented and similar trends of adverse events incidence were associated to short and long-term treatment. Nicole Selenko-Gebauer in her presentation combined the description of mechanisms of action with clinical pharmacology findings and clinical outcomes in order to present a comprehensive picture of the new therapeutic options offered by biologics. A workshop on clinical cases closed the session and provided the possibility to discuss how old and new treatments could be applied in clinical practice.
The last session of the Symposium provided an overview of treatments that will be available for psoriasis. Frank Nestle introduced the genetics of psoriasis hypothesizing that, in the future, through evidences collected by the whole genome scans could become available, new “smart” drugs that will target pathogenetic mechanisms and mediators are under investigation. Wayne Gulliver’s second lecture was focused on the influence that the HLA Cw6 allele has on the appearance, course and response to treatment of psoriasis. Drugs that will target HLA Cw6 may be able to clear lesions and prevent relapses. According to Peter Foley, pharmacogenetics and pharmacogenomics can improve the personalization of psoriasis treatment, but the speaker clearly exposed the difficulties that have to be faced, first of all the polygenic trait of psoriasis.
The last lecture of this session offered interesting clues on co-morbidities of psoriasis. Giampiero Girolomoni, after a comprehensive overview on psoriatic arthritis, showed new data collected by his group that evidenced a tight link between psoriasis and the Metabolic Syndrome, thus confirming findings of other authors. A panel discussion on challenges related to psoriasis management and exhausting conclusions by Carlos Ferrándiz closed the Symposium.
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My name is Robert Fischer and I am Medical Director of the IVF-Unit at the Fertility Centre in Hamburg, Germany. I am also a proud member of the Scientific Committee of the Serono Symposia International Foundation.
In recent years what do you think have been the most important advancements in ART?
The most important advances in recent years in ART are probably Intracytoplasmic Sperm Injection (ICSI) and the genetic analysis possibilities of the oocyte and embryo. ICSI significantly increases the success rate of IVF and offers good chances to achieve pregnancy also to couples that in the past had very few possibilities to conceive. Even couples where the male has a severe impairment of spermatogenesis now can undergo IVF cycles successfully. This is a progress not only from the scientific point of view, but also from a social one. A man that survived cancer in childhood or adolescence in the past was condemned to give up the conception of a child and now, thanks to ICSI, he can achieve it. Think of what a change in life and in the psychology of these subjects this new opportunity can produce. Genetic analyses should change dramatically the rate of success of IVF and when they will become routinely used the cost-effectiveness rate of ART will improve significantly.
Is there a reliable parameter to evaluate IVF outcomes?
Even among experts there is a heated debate on this topic. For sure the meaning of “most reliable” parameter changes according to the player that evaluates it. The “take home baby” rate is, for example, the parameter that better express the couples’ opinion about success of IVF. If we ask for a parameter that better evidences the efficacy of a procedure related to IVF, probably the best one is the number of children delivered per started cycle. In order to compare results of different centers, the outcome of treatment in a standardized patient under 35 years of age would be probably helpful. My hope is that, in the future, few standardized and reliable parameters will be universally used in the evaluation of ART outcomes. This could ease comparisons in the results and also the general feeling about ART could be improved.
What is the future of preimplantation genetic diagnosis (PGD)?
I think that in the future it will concentrate more on aneuploidy screening of the embryos and will provide a complete screening of all twenty-three chromosomes to make a selection of the suitable embryo for transfer to achieve a singleton healthy pregnancy! Couples with high risk of IVF cycle failure - as previous recurrent implantation failures, recurrent miscarriages and where the male has a non-obstructive azoospermia - can markedly increase the success rate through PGD screening. The first step in a wider use of PGD screening is the availability of studies with reliable methodology and well performed that support the usefulness of this procedure. In this way the characteristics of couples where PGD screening has the best cost/efficacy balance can be identified.
Is there room for improvement as far as ovarian stimulation is concerned?
Yes, in the short term the available drugs should become more reliable. This means that the effective biological activity of molecules contained in these drugs must be foreseeable. Devices that can ease drug administration could improve compliance and increase adherence, factors that influence success rates. In the medium-long term, oral drugs (HMG) to avoid injections, or long acting drugs will be available. These will probably be helpful to make treatments simpler and reduce costs, making these drugs available to a larger portion patient population who need this kind of treatment.
Thank you very much.
Neurology
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Dermatology
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The aim of this conference is to review and discuss current approaches in ovulation induction, as well as to look at various emerging techniques such as in vitro maturation to understand the applicability to current practices. Several areas where unanswered questions remain, such as implantation difficulties, will be elaborated whilst other areas, such as the usage of antagonist regimes where practices differ by country, will be discussed to share accumulated experience to-date.
The aim of the conference will be to understand the role of LH in follicular growth in the natural cycle and in ovulation induction as well as to define the situations and target groups of patients that will need LH supplementation during their ovulation induction. This will be discussed by experts who will address the physiology as well as share the experience of the last years of different kind of LH supplementation.
A closer look at the area of fertility preservation in those with malignant disease is the aim of this congress. The program is designed to benefit clinicians, scientists and paramedical staff involved in the treatment of reproductive and oncological disorders.
An indepth analysis of the diverse surgical techniques used to treat sterility will be addressed here. Also under discussion will be the ongoing debate regarding whether there is an effective need to undergo surgery for purely reproductive purposes as an alternative, or in association, to the current pharmacological therapies to treat infertility. The conference will offer a live session on endoscopic surgery, and also renowned national and international experts will confront their respective experiences on gynecological problematics which still have not reached a consensus on the best therapeutic approach in order to explore the universe of reproductive medicine where many questions still remain to be clarified.
The objective of this course is to provide participants with the most updated knowledge on IVF procedures and with skills useful in IVF practice. At the end of the workshop, among the various learning objectives, the attendees will have acquired information on the current ethical, regulatory and legal issues on IVF in Europe, the ability to diagnose infertility in males and females, the background needed to choose the right IVF procedure and the best way to interact with patients.
The objective of this workshop is to provide its participants with up-to-date information and views on Multiple
Sclerosis (MS) in order to ensure optimal disease and treatment management of persons living with MS.
MS Nurse is an annual workshop created to encourage the dissemination of scientific knowledge among nurses from all over the world in the field of Multiple Sclerosis. Presentations will provide the latest information in MS in the following areas: Advanced Disease Management, Problem Symptoms and Psychosocial & Cognitive Aspects. In addition to didactic presentations, group workshops will allow nurses to discuss these topics in relation to their own practice.
This is an educational programme created to encourage the dissemination of scientific knowledge in the field of MS. It will stress the benefits of new diagnostic tools for defining the natural history of MS and disease activity monitoring. Current diagnostic criteria for MS will also be reviewed in the light of new medical evidence. A review of recent clinical trials and treatment optimisation guidelines will also be presented.
Please note: The official language of the conference will be Spanish. Simultaneous Translation English-Spanish, Spanish-English will be available.
