Robert J. Fox, MD

“We’ve come to appreciate that progressive MS is 2 different components—we have the active inflammation that can still go on in progressive MS and can add to and contribute to the progression we see in progressive MS, and we have something else.”

Currently, the multiple sclerosis (MS) treatment landscape is both robust and in need. Although more than a dozen disease-modifying therapies are available to treat relapsing MS, the progressive form of the disease is lacking several strong treatments, with ocrelizumab (Ocrevus, Genentech) as the only current option.

With this challenge persisting, researchers such as Robert J. Fox, MD, a neurologist at Cleveland Clinic, have come to appreciate that progressive MS consists of 2 components: active inflammation, as well as a second portion that remains cloudy. While many, including Fox, are leaning toward that unknown component being neurodegeneration, the development of therapies to address the has become increasingly difficult.

Despite this, several are currently making their way through the pipeline, one being ibudilast, a small molecule normally used in the treatment of asthma and post-stroke vertigo in Asia. Fox and colleagues recently reported positive phase 2 results of the therapy, in which it showed a powerful effect on slowing brain atrophy in progressive MS.

At the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany, Fox sat with 

 to discuss these challenges, and to share his clinical experience with ibudilast.

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The neurologist from Cleveland Clinic discussed the challenges of treating progressive MS, and shared his clinical experience with ibudilast.

Robert J. Fox, MD: Treating Progressive Multiple Sclerosis

“What we’ve found is that therapies that decrease active inflammation in multiple sclerosis also decrease neurofilament.”

One of the biggest unmet needs in multiple sclerosis care are biomarkers to evaluate the medicines used to treat the condition. With more than a dozen available therapies, choosing between them has become difficult, and determining the success of any given therapy is increasingly important.

At the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany, Robert J. Fox, MD, a staff neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis, spoke with 

 about the potential of one biomarker, neurofilament light, to do just that.

When neurons are damaged, neurofilament is released into the spinal fluid, as well as, eventually, the blood—making it an easy to assess marker. Fox provided insight on the current knowledge of the biomarker’s ability to inform clinicians of the success of disease-modifying therapies, as well as how these therapies interact with neurofilament.

Fox added that thus far, findings with anti-inflammatory therapies have suggested that there may be a use for this biomarker to follow current patients’ response to available therapies. 

The staff neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis spoke about the current understanding of the biomarker.

Robert J. Fox, MD

Articles

Robert J. Fox, MD: Treating Progressive Multiple Sclerosis

Robert J. Fox, MD: Neurofilament Light as a Biomarker of Treatment Response