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AAN Expert Exchange: Sphingosine-1 Phosphate Modulation in MS

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A trio of experts in multiple sclerosis exchanges their thoughts on the use of the sphingosine-1 phosphate modulating class of medicines in treating the disease. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

Transcript below. Edited for clarity.

Ahmed Obiedat, MD, PhD: You kind of mentioned a little bit also about the S1P modulators. Do you have anything to add on their role within the central nervous system and recent findings?

Regina Berkovich, MD, PhD: I think it's very intriguing, the fact that they seem to be targeting that smoldering inflammation because we know there is evidence that they cross the blood-brain barrier—and indeed, that was [shown] in animal studies. There were some very interesting data on preservation of brain volume and gray matter volume, and that translated into the prevention of disability progression.

I am very hopeful that this is something that we can incorporate into practice, relatively soon, and even though we may not have all the tools to monitor, let's say, brain volume change—some of us may, like I do, but some may not, and that's OK—we still can give our patients benefit from what we know, right? So, if you have a patient on injectable therapy, and that person is not doing too well in terms of progression, remember that all the newer medications got approved for active secondary progressive MS.

That's something we didn't have [until] just recently, right? So, that means that FDA finally understood the importance of treating patients with secondary progressive MS. Don't conclude that your patient who has been on Copaxone [glatiramer acetate] forever cannot do any better or slow down their progression. It's probably possible, but patients may have to change their medicine. We, of course, are always available for the consultation for those patients. Sometimes I get requests for the consultation just to talk about different therapies because there are so many of them, and it would be unfair for us to expect general neurologists to know all the details of newer therapies. Therefore, I would encourage general neurologists to refer patients, even for a virtual consultation, for changes to different disease-modifying therapies where we can share the knowledge and provide that time, that normally you wouldn't have for your follow-up patient. For the consultation, it will be a new patient to us, and we can give that whole hour of detailed conversation and comparison of the medications.

Ahmed Obiedat, MD, PhD: These are great messages talking about the complexity of, really, the current landscape of treatment in MS.