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Understanding the Evolving Care of Rehabilitation and Stroke Recovery

Cladribine shows promising results in reducing relapse rates for patients with relapsing multiple sclerosis after inadequate response to injectable therapies.

MS Therapy Cladribine Remains Effective in Patients With Suboptimal Response to Prior Injectable DMT

Test your neurology knowledge with NeurologyLive®'s weekly quiz series, featuring questions on a variety of clinical and historical neurology topics. This week's topic is on the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting.

NeurologyLive® Brain Games: June 1, 2025

Videos

The associate professor of medicine at the Cleveland Clinic Lerner College of Medicine highlighted the importance of early, multidisciplinary intervention for patients with multiple sclerosis. [WATCH TIME: 3 minutes]

Starting Comprehensive Multiple Sclerosis Care at Initial Diagnosis: Mary R. Rensel, MD, FAAN, ABIHM

Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine; Director, Pediatric Multiple Sclerosis and Wellness, Mellen Center, Cleveland Clinic; Founder, Brain Fresh

Host Jeffrey Wilken, PhD, chats with Riley Bove, MD, about the third day of the 2025 CMSC Annual Meeting in Phoenix, Arizona.

CMSC Live: 2025 Annual Meeting Day 3

AHN Saint Vincent Hospital offers advanced neurological care, reducing wait times and providing local access to specialized treatments for various conditions.

Neuroscience at AHN Saint Vincent: Advanced Treatments and Collaborative Care Closer to Home

NeurologyLive is your direct connection to the latest neurology news and interviews with expert neurologists in multimedia formats.

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Clinical

 multiple sclerosis (MS) Advanced Practice Providers (APPs) clinical focus page is a concentrated place for the latest information on the care and management of patients with MS, including relapsing MS and progressive MS, as well as related and demyelinating disorders such as neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. This page includes podcasts, videos and expert interviews, and news about the latest study and clinical trial findings, FDA actions, and clinical guideline updates.

 to subscribe on your favorite streaming service.

The Mind Moments podcast features exclusive interviews with leaders in the field discussing the latest research and disease management strategies across the breadth of neurology, including epilepsy, multiple sclerosis, Parkinson disease, dementia, sleep disorders, and more.

In this episode, "Previewing the 2025 ACTRIMS Forum," Véronique Miron, PhD, The John David Eaton Chair in Multiple Sclerosis at the University of Toronto, gave a clinical overview of the 2025 ACTRIMS Forum, which is set to be held February 27-March 1, in West Palm Beach, Florida. Miron, an expert in the field, spoke on the reasons behind this year's theme of "Making Connections," as well as some of the most notable and innovative sessions attending clinicians should keep their eyes on. Additionally, she spoke on how the curriculum at this year's meeting aligns with the most recent MS McDonald Diagnostic Criteria that was presented at ECTRIMS 2024. Miron also spoke on the different seminars that cover drug development, innovative new treatment approaches, and Bruton Tyrosine Kinase (BTK) inhibitors. Furthermore, she provided commentary on how this year's meeting differs from previous iterations of ACTRIMS, highlighting some of the changes to the agenda and the advances in MS research.

The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here:

FDA Approves Axsome Therapeutics’ AXS-07 for Migraine Treatment

FDA Approves Vertex Pharmaceuticals' Suzetrigine for Acute Pain Management

FDA Approves Apomorphine Infusion Device SPN-830 as New Parkinson Treatment

 – Reasons behind "Making Connections" theme 

 – Overviewing key unique sessions and forums from the meeting

 – Aligning curriculum with 2024 MS McDonald Criteria

 – Drug development topics from ACTRIMS 2025

 – Differences between ACTRIMS 2025 vs ACTRIMS 2024

 to subscribe to the Mind Moments podcast. Be sure to leave a rating and review for the show. Thanks for listening!

Hoping to listen on your favorite podcast app? See below:

Mind Moments®, a podcast from NeurologyLive®, brings you an exclusive interview with Véronique Miron, PhD. [LISTEN TIME: 17 minutes]

Episode 134: Previewing the 2025 ACTRIMS Forum

Jack P. Antel, MD, professor of neurology and neurosurgery at McGill University, reflected on key advances in neuroimmune research and their implications for understanding and treating MS. 

Evolving Clinical Insights Into Neuroimmune Mechanisms and Multiple Sclerosis Progression

Move fast—April 30, 2025, is the final day to take advantage of early bird savings!

Register Today for the 2025 CMSC Annual Meeting in Phoenix!

Bruce Bebo, PhD, and Amit Bar-Or, MD, FRCPC, FAAN, FANA, discussed the impact of the John Dystel Prize on multiple sclerosis research and its role in shaping future clinical advancements. 

Advancing MS Research Through Recognition and Innovation: The John Dystel Prize

In a large Swedish MS cohort, higher combined intake of lean and oily fish was linked to significantly reduced risks of confirmed disability worsening and EDSS progression, independent of lifestyle factors.

Fish Consumption Leads to Better Disability Progression in Multiple Sclerosis

The associate professor of medicine at the Cleveland Clinic Lerner College of Medicine highlighted the importance of early, multidisciplinary intervention for patients with multiple sclerosis. 

"You always need to have a team of support around you when you live with MS."

2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting

, held May 28-31, 2025, in Phoenix, Arizona, the session "The Interdisciplinary Approach to Wellness in MS” chaired by Mary Rensel, MD, FAAN, highlighted the vital role of collaborative care models in managing multiple sclerosis (MS). During the session, Rensel, director of Pediatric Multiple Sclerosis and Wellness at the Mellen Center of the 

, and Alyssa DeCarlo, MS, OTR/L, MSCS, presented on integrating wellness into MS care through a comprehensive, team-based approach.

Further in the presentation, Mary Mazzola, MA, CCC-SLP, and Hannah Malloy, PT, DPT, NCS, expanded on the “looping” model of interdisciplinary care, emphasizing continuous, dynamic collaboration among health care providers. The session also included a panel of case discussions showcasing real-world applications of interdisciplinary strategies across wellness domains such as cognitive health, physical function, emotional well-being, and lifestyle management. At the end, Rensel concluded the session by reinforcing the necessity of early and sustained interdisciplinary coordination to optimize patient outcomes in MS care.

, who also serves as an associate professor of medicine at the Cleveland Clinic Lerner College of Medicine, sat down in an interview with 

to outline the comprehensive care model used at the Mellen Center at Cleveland Clinic for patients with MS. She stressed the value of integrating therapies such as occupational, physical, speech, and psychological support from the time of diagnosis. Through a case example of a young mother experiencing early MS symptoms, Mary illustrated how collaborative, team-based care can ultimately help patients maintain their quality of life and return to valued daily activities.

Click here for more coverage of CMSC 2025.

REFERENCES
1. Rensel M, DeCarlo A. The Interdisciplinary Approach to Wellness in MS. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, AZ. The Interdisciplinary Approach to Wellness in MS.



SAP Partners

The vice chair of neurology at the Hospital Clínico San Carlos in Madrid highlighted the growing importance of detecting and managing progression in multiple sclerosis, particularly PIRA. 

Identifying and Treating Progression in MS Beyond Relapses: Celia Oreja-Guevara, MD, PhD

"We need to detect this silent progression that is part of the smoldering disease, and at the same time we need to treat this progression, because it is doing the major disability of the patients."

, held May 28-31, 2025, in Phoenix, Arizona, a symposium titled "BTKi Update: Breaking Through the Blood-Brain Barrier & Transforming Smoldering Disease as a Driver of Disability" offered a comprehensive look at the evolving role of Bruton’s tyrosine kinase inhibitors (BTKis) in multiple sclerosis (MS). Chaired by Robert J. Fox, MD, FAAN, the session began with Celia Oreja-Guevara, MD, PhD, outlining the urgent need to better monitor and manage disability accumulation in MS, particularly progression independent of relapse activity.

Following Oreja-Guevara ‘s presentation, Fox then delved into the mechanistic rationale behind BTK inhibition, highlighting its ability to modulate smoldering neuroinflammation in the CNS. Additionally, Anthony L. Traboulsee, MD, FRCP, provided practical clinical insights, bridging the gap between emerging science and real-world applications. The session concluded with a panel discussion with the speakers focused on clinical strategies and future opportunities for targeting progression and disability in MS through BTKi-based therapies.

During the meeting, Oreja-Guevara, vice chair of neurology at the Hospital Clínico San Carlos in Madrid, sat down with 

 to discuss the clinical shift in MS care from managing relapses to addressing disease progression, especially progression independent of relapses. In the discussion, she emphasized the limitations of the EDSS scale in capturing early signs of worsening and advocated for the use of alternative functional assessments, patient-reported outcomes, advanced MRI markers like slowly expanding lesions, and blood biomarkers such as GFAP. These tools, she suggested, may enable earlier detection and intervention when new treatment options, such as BTK inhibitors, become available.

REFERENCES
1. Oreja-Guevara C. Monitoring & Managing Disability Accumulation: Addressing an Unmet Need. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, AZ. Independently Supported Symposium 3.

The vice chair of neurology at the Hospital Clínico San Carlos in Madrid highlighted the growing importance of detecting and managing progression in multiple sclerosis, particularly PIRA. [WATCH TIME: 6 minutes]

The professor of neurology and neurosurgery at McGill University discussed the evolution of multiple sclerosis treatment, the need for earlier intervention, and the pressing scientific questions surrounding neuroinflammation. 

Advancing MS Care Through Early Intervention and Deeper CNS Insights: Jack P. Antel, MD

“If we compare ourselves to the generation before us, they didn't have the tools that we have. In particular, the imaging tools like MRI which allowed us to see the disease, and also the technology for making therapy, especially recombinant molecules.”

Prior research into neuroimmune interactions has helped shape current and future approaches to multiple sclerosis (MS) care. Advances such as in understanding immune-central nervous system (CNS) dynamics have informed the development of targeted therapies, such as B cell–depleting agents, and improved monitoring tools like neurofilament light chain as a biomarker in MS.

Evolving imaging technologies, including PET and MRI, continue to enhance early diagnosis and disease tracking.

These developments reflect how prior insights are contributing to more refined and personalized treatment strategies.

This was a topic featured in the Kenneth P. Johnson Memorial Lecture, presented at the 

2025 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum

, held February 27 to March 1, in West Palm Beach, Florida, by 

 professor of neurology and neurosurgery at McGill University.

, ACTRIMS Forum Chair, set the stage with a welcome address. After the Forum, Antel had a conversation with 

 to futher reflect on how advances in imaging and molecular therapies have transformed the field for the MS community. 

During the conversation, he emphasized a paradigm shift toward early therapeutic intervention to prevent relapse-driven disability in patients living with MS. Antel also outlined the emerging realization that systemic immune activity alone may not account for disease progression and that future therapies should address CNS-specific mechanisms. He also highlighted key unanswered questions in neuroimmunology, including the role of Epstein-Barr virus, patient-specific CNS responses, and subtle symptoms like cognitive dysfunction.

Click here for coverage of 2025 ACTRIMS Forum.

REFERENCES
1. Eva L, Pleș H, Covache-Busuioc RA, et al. A Comprehensive Review on Neuroimmunology: Insights from Multiple Sclerosis to Future Therapeutic Developments. Biomedicines. 2023;11(9):2489. Published 2023 Sep 8. doi:10.3390/biomedicines11092489
2. Oh J, Bar-Or A. Precision neuroimmunology in multiple sclerosis - the horizon is near. Nat Rev Neurol. 2024;20(9):507-508. doi:10.1038/s41582-024-00992-6
3. Charabati M, Wheeler MA, Weiner HL, Quintana FJ. Multiple sclerosis: Neuroimmune crosstalk and therapeutic targeting. Cell. 2023;186(7):1309-1327. doi:10.1016/j.cell.2023.03.008
4. Antel JP. Neuroimmune Interactions: How Past Lessons Can Inform the Present and Future of MS Care. Presented at ACTRIMS Forum 2025; February 27 to March 1; West Palm Beach, Florida. Kenneth P. Johnson Memorial Lecture.

The professor of neurology and neurosurgery at McGill University discussed the evolution of multiple sclerosis treatment, the need for earlier intervention, and the pressing scientific questions surrounding neuroinflammation. [WATCH TIME: 4 minutes]

Experts discussed how aging impacts multiple sclerosis management, treatment decisions, and overall patient health.

The Role of Aging in Multiple Sclerosis Care

, held February 27 to March 1, in West Palm Beach, Florida. This CE-accredited meeting featured a single track of scientific and clinical presentations focused on advancing research and treatment for multiple sclerosis (MS) and related disorders. The 2025 theme, "Making Connections," emphasized linking aging to MS pathology, exploring cross-disorder and neuroanatomical connections, bridging data with clinical application, and investigating brain repair and protection. Designed for researchers, clinicians, students, and fellows, the 

 Forum provided opportunities to engage with experts, optimize MS management, and explore emerging concepts in neuroimmunology.

 held a roundtable discussion with MS experts who talked about key advancements in MS treatment and research that were discussed during the 2025 ACTRIMS Forum. The experts shared their thoughts on which sessions from the Forum that could have the most immediate impact on clinical practice and examined how emerging therapies could transform MS treatment in the coming years. They also explored the role of AI and machine learning in MS as well as the increasing focus on aging and MS progression. The panelists in this conversation included neuroimmunologist Moein Amin, MD, neurologist 

In this episode, experts highlighted aging as a key topic in MS care. They emphasized the growing need to understand the biological and clinical implications of aging, including comorbidities, treatment discontinuation, and general health maintenance. As patients with MS live longer because of effective therapies, the experts noted that clinicians are increasingly focusing on personalized approaches that account for aging-related changes and overall wellness.

 So what I'm going to do is ask if anybody has any closing remarks on overall, their time at ACTRIMS, and if they're looking forward to any thing else for the next meeting?

 I would just say one other big topic that was really exciting and we didn't get to talk about necessarily was aging in MS. And that's, again, another kind of relevant topic for all of us clinicians, because many of our patients are continuing to live longer. And with the ability of the disease-modifying treatments to keep the disease more stable over a more prolonged period of time, there's this opportunity to treat patients potentially longer term. We're still trying to understand all the implications of aging in MS—whether that's accelerating biological aging or the effect on immune cells, and what impact that will have on our treatments. That's something that McGinley has been involved in, obviously—whether that’s stopping disease-modifying therapies or potentially de-escalating. So that's an area that I look forward to hearing more about in future meetings as well.

 Yeah, I completely agree. I think we absolutely have an aging population. We think of MS as a young person’s disease, diagnosed in their 20s and 40s. And we're fortunate now that our treatments are quite effective and our patients are living longer, doing better, but it also means that we're caring for patients, well into their sixth, seventh, eighth-plus decades. So understanding the biological changes—both that biological age versus chronological age, the impact of the comorbidities that occur as people age—and then, I mean, some of the work that we presented at ACTRIMS was thinking more about discontinuation.

And Conway gave another wonderful talk on the DISCOMS data and several of the other discontinuation trials, and it's a very hot topic because there's not a clear answer. And so really, as we try to, again, think about a more personalized approach—and that’s some of the work we presented on developing, using machine learning, a personalized risk model for discontinuation—so, efforts in that way. So I think a lot around treatment as our patients are aging, but I think underpinning that is understanding the biology and the other comorbid conditions that are happening. I agree, it's going to be a really important topic as we move forward.

And I guess just building on the aging issue, I think that it really kind of underscores the importance of general health in MS that I've been trying to emphasize more and more with my patients in clinic, as Dr. McGinley was referring to. As patients get older, they get more comorbidities, and there's mounting evidence of the impact of comorbidities on MS. And then, I think it ties together other features as well. There was an interesting abstract about biological age as measured by metabolomic profiles, and how there was a relationship between that and social determinants of health. And we know social determinants of health are also, you know, associated with factors of general health. And so I think it brings together this, you know, the whole picture for patients with MS and how the things that can come with aging also tend to make MS worse. And so that's something that we need to focus on, and we need to encourage our patients to be aware of—to manage their comorbidities, to get appropriate cancer screenings, and to be mindful of their general health. Because I really find that those patients who exercise, who don't smoke, and who take their disease-modifying therapies—they tend to do the best over the long term with their MS.

Experts discussed how aging impacts multiple sclerosis management, treatment decisions, and overall patient health. [WATCH TIME: 5 minutes]

Experts discussed the current and future applications of AI and machine learning in multiple sclerosis research and clinical care, highlighting both opportunities and limitations. 

AI and Machine Learning in MS: Promise and Practicality for Clinical Practice

In this episode, clinicians explored how artificial intelligence and machine learning can be potentially integrated into MS research and practice. They highlighted current uses in imaging, electronic health records, and clinical transcription, as well as future potential in genetic analysis and personalized medicine. Although the promise of these tools is significant, from improving diagnostic accuracy to easing clinical workflows, the clinicians emphasized the importance of understanding their limitations and ensuring close collaboration with data science experts.

: Another hot topic that is being talked about right now in the field, and that was also presented at the meeting, was AI and machine learning—using it in research and also in clinical practice. So, what do you think are maybe the most promising applications from this, and what challenges do you think still remain?

 Yeah, so I think there was a good session led by Russell Takeshi Shinohara, PhD—he was actually leading a machine learning session at the ACTRIMS—that he nicely summarized a lot of the history in using machine learning. He actually noted an interesting fact that I wasn’t aware of either. People proposed using machine learning to analyze MRIs in MS as early as 1989, which was quite surprising to me. There was an early paper he pointed out that used neural networks to identify lesions in MRI for patients with MS back in 1989, which was quite interesting.

But the field obviously is growing—in conjunction with the machine learning field, MS clinicians and researchers are also starting to use more and more of these methods and apply them in various different applications. We also had the Brain Exchange sessions with Dr. Daniel Ontaneda, MD, PhD, which I led and moderated—an interesting discussion between clinicians, researchers, and other involved parties around the use of machine learning in MS research and clinical application.

There’s a lot of different applications. One big application of machine learning is imaging, where we could use machine learning to develop more sensitive and specific imaging contrast—whether that’s reduction of artifacts, developing synthetic sequences that aren’t obtained to reduce scan time, or developing new sequences altogether. Harmonization across different scanners and acquisition techniques, lesion segmentation and phenotyping, identifying diagnostic and prognostic biomarkers such as central vein sign and paramagnetic rim lesions—using automated methods to do those. That’s obviously a hot topic and of interest in neuroimaging.

But there are also a lot of other applications that have come about, including a hot topic, which is ambient listening—that is being used in clinical practice at a lot of centers, where AI can be used to transcribe conversations with the patient. That can save time and also allow the clinician to spend more time with the patient rather than typing into the computer.

There are a lot more applications, including genetic data. There was data presented about using a genetic risk score to potentially diagnose someone with MS using genetic data, which is another area to apply machine learning because of the high dimensionality of the data.

But the main point that came out of our discussion was that although there are a lot of applications, we should look at AI or machine learning as a tool—like any other tool. You can use it to achieve a lot of different things, but the important part is being aware of its limitations and making sure you don’t misapply the tool—similar to MRI, for example. MRI is not perfect. There are limitations, but we use it in clinical practice daily to achieve a lot of different goals. Similarly, AI can be used to achieve a lot of different goals in clinical practice or research. We just have to be aware of the limitations of each technique—which is easier said than done—but that’s something that, in my mind, requires collaboration with data scientists and experts in the field.

 There was a talk by Dan Milea, MD, PhD, from Singapore that I thought was really fascinating, where he was using OCT data and feeding it into a deep learning model. And he was showing that the model could actually identify all sorts of different conditions just from examining patients' retinas—including MS, hypertension, I think Alzheimer disease was also mentioned. So that’s really exciting to me.

Other things, just thinking aspirationally, that I think would be exciting developments for AI and MS would be that we kind of have this wealth of information in our electronic medical records that we try to use for observational studies. But actually getting good data from the electronic medical record is a huge challenge and usually requires manual extraction. We’re getting better at trying to get the data out, but usually you need to understand language in order to grasp what’s going on with each patient. And if we had an AI model that could go through the charts and pull out data—and then analyze it for patterns that maybe we would never think of—I think that could be really exciting.

And then lastly, just on the clinical front, Amin was referring to AI scribes, which we’re supposed to be trying here at Cleveland Clinic soon, and we’re all excited about. But I’m also excited about the prospect of these patients who don’t have a straightforward diagnosis—they come to see you with a suitcase full of records—and the possibility that AI might be able to help us process those records and summarize the findings. Because generally, in clinic, we don’t have enough time, unfortunately, to flip through 1000 pages of records. That’s really exciting to me, and I think it could bring benefit to a lot of patients in the near future.

 I think both of you made excellent points. I think that imaging is definitely the easiest—or the application where we’re already using a lot of AI—and I think that’s the natural starting point. And then I think Conway pointed out a couple of the very clinical applications when it comes to collecting and mining data that really just augment our ability as clinicians to care for patients.

I think another sort of aspirational goal is really the idea of personalized medicine—and Amin kind of alluded to that with the genetics—and there was a lot on proteomics, too. And then Conway’s point about the amount of information in the EHR—we kind of do an algorithm in our head, I think, just based on our medical training, and we try to piece it all together. But the development of more tools that utilize AI to help guide diagnosis and treatment decisions for patients using that individualized approach—I think that would be really fabulous.

Because we've all been reiterating that every MS patient is different when it comes to their biology, their symptoms, their presentation. So there's really not a good one-size-fits-all for any diagnostic or treatment approach. I think the potential of AI and machine learning to help guide that and really augment our ability as clinicians to care for patients would be wonderful.

Experts discussed the current and future applications of AI and machine learning in multiple sclerosis research and clinical care, highlighting both opportunities and limitations. [WATCH TIME: 9 minutes]

Experts discussed the promise and uncertainty surrounding BTK inhibitors and CAR T-cell therapy in addressing progressive multiple sclerosis.

Emerging Therapies and the Future of MS: Insights on BTK Inhibitors and CAR T-Cells

In this episode, experts explored the evolving therapeutic landscape of MS, focusing on Bruton tyrosine kinase (BTK) inhibitors and CAR T-cell therapy. Although BTK inhibitors have shown mixed results in relapsing MS, there is cautious optimism about their potential role in slowing disability progression, particularly as adjunct therapies. The speakers also highlighted the importance of identifying patients with compartmentalized inflammation and emphasized the need for more sensitive imaging and biomarkers in clinical trials. CAR T-cell therapy was discussed as a promising yet early-stage intervention, with an eye on safety and its ability to target previously inaccessible inflammation.

 I think all of you mentioned a little bit of some of the emerging therapies that were covered in the meeting—BTK inhibitors and CAR T-cell therapy. How do you see those potentially reshaping MS treatment in the next couple of years?

 Well, I think the BTK inhibitors are still an area that is generating some confusion in terms of how they're going to be used in the future. As you're probably aware, the results in relapsing MS have been somewhat disappointing to date, although the fenebrutinib phase 2 study, they presented some of the open-label extension results, and those were very strong in terms of reducing MRI disease activity. But when we heard the results of the GEMINI study, that was definitely not exactly what we were hoping for, and evobrutinib also didn’t pan out as we had hoped. So, we’ll be interested to see the results of the phase 3 studies of fenebrutinib in relapsing MS.

But it kind of begs the question—as we see some reduction in disability progression in the HERCULES study with tolebrutinib—is it possible that this could potentially be an adjunct therapy that we might use in conjunction with some of the treatments that have more profound effects on the relapsing phase of the disease? And if we did do that, how much risk would there be? Particularly given that the BTK inhibitors can sometimes lead to severe liver toxicity, and that there have been deaths associated with that—how safe will it be? But I think we’ll still have to wait to see how that data plays out, especially as we get some of the subgroup analyses from the tolebrutinib studies.

 I think those are great points. I think it’s going to be really tricky, right? Because, as you pointed out, the relapsing/remitting data is not as robust, and obviously the biggest need is in progressive [MS]. But the question is are we going to be ready to take people off medications?

And the idea of, like, a combination therapy is not something we’ve thought about in a while in MS, because obviously, previously, we kind of abandoned that topic. But now that we’re thinking about the disease more as a spectrum with these different biological mechanisms, there’s some rationale for it. But obviously, all of these studies were done just with the medication and not in combination.

And I think your safety question is going to be the hard one from, like, a translation-to-clinical-practice standpoint. We're all going to be anxious to kind of help with those progressive, neurodegenerative, chronic active-type lesion biology. But the question is identifying those patients, right, that have predominantly that biology and aren’t going to be at risk still for relapses and new lesions if we don’t find that the BTKis affect that enough to have them on a monotherapy.

So, I think we’re all still waiting on the full trial results and the safety data in the label and show much we’re going to have to monitor these patients. But I’m with you in that it is more attractive to think about it as an adjunct, or like do we start doing more than one therapy, as is done in other disease states, right? I mean, a lot of other autoimmune conditions think about several different treatments, but we’ve not done that yet. So I think that it'll be interesting to see how the field goes there.

 The rheumatologists probably wouldn't ‘bat an eye’ about combining these treatments.

 Exactly. I feel like both our patients and neurologists are rather risk-averse. So it'll be good to push us out, because obviously we need to be doing something different when it comes to progression.

 Yep, I also completely agree with what both McGinley and Conway said. Yeah, I think we’re all eagerly awaiting additional data for both CAR T and BTK inhibitors to try to target the compartmentalized inflammation that some of our other immunomodulatory treatments can’t necessarily target as well as they should—to hopefully try to treat the smoldering inflammation that potentially is the main contributor for progression in multiple sclerosis.

And one of the limitations always has been identifying sensitive biomarkers in all of these trials. That’s been a challenge for us. Traditionally, of course, the rate of relapses and new MRI lesions or brain volumes have been used as traditional imaging clinical biomarkers for trials that have been set to study these medications. But with some of these studies perhaps not showing the results that we anticipated them to show, it begs the question of whether we’re using sensitive enough imaging or clinical biomarkers to potentially detect impactful change that these drugs may be exerting.

For example, as McGinley mentioned, it’s useful to use potentially paramagnetic rim lesions as a biomarker for not only selection but perhaps even treatment effect, as some of the sessions did show, for example, the 2-year data with the PRLs with ocrelizumab showed that there wasn’t any change in the count of the PRLs. But the study that was shown or presented at ACTRIMS showed that the actual quantitative measures in the PRLs potentially change over 4 years, and not the actual count. So that’s an area of active research—to try and identify good biomarkers so that in the clinical trial, we can design the trials around them appropriately.

 Like Amin was saying, it’s really exciting that the CAR T therapies might be able to target the compartmentalized inflammation that the treatments we have right now—the antibody treatments—really are not reaching. And what effects that might have, especially on progressive MS.

Obviously, there’s a lot of safety concern that can go along with that, like immune effector cell-associated neurotoxicity syndrome (ICANS), and then also, will targeting CD19 and removing a larger proportion of your B cells lead to more complications than we’ve seen with CD20 therapy so far—those are questions that will still have to be answered. I think CAR T is still very preliminary at this point, but the abstracts that I saw at the conference—mainly posters—nobody reported any serious adverse events that I picked up on, so that was nice to see.

Experts discussed the promise and uncertainty surrounding BTK inhibitors and CAR T-cell therapy in addressing progressive multiple sclerosis. [WATCH TIME: 8 minutes]

The director of NYU Langone's Multiple Sclerosis Comprehensive Care Center discussed the importance of early, high-efficacy treatment for pediatric MS. 

Advancements and Challenges in Pediatric Multiple Sclerosis Treatment: Lauren B. Krupp, MD

The director of NYU Langone's Multiple Sclerosis Comprehensive Care Center discussed the importance of early, high-efficacy treatment for pediatric MS. [WATCH TIME: 3 minutes]

MS Advanced Practice Providers

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