AAN Highlights: Multiple Sclerosis Disease Modifying Treatments

Jason Freeman, MD, MBA: Welcome to AAN 2023. I'm your host, Dr Jason Freeman, Medical Director, Novartis Medical Affairs, providing you with updates from AAN 2023. The information herein is provided for disease educational purposes only, and is not intended to be, nor does it imply medical or diagnostic advice. Joining me today is Dr Arsalan Syed. Welcome.

Arsalan Syed, PhD: Thank you for having me. Appreciate it.

Jason Freeman, MD, MBA: Thanks for being here. We will discuss key takeaways from the session titled Multiple Sclerosis Disease Modifying Treatment.

Jason Freeman, MD, MBA: Dr Syed, can you provide us with updates on efficacy data, either as it relates to new or emerging DMTs presented during the session?

Arsalan Syed, PhD: Well, thank you for that question, Jason. The focus of the session was looking at the available DMTs that have been approved by the FDA, these disease-modifying therapies. Not only that, it also actually focused on the requirement for diversity in our clinical trials as well and also it shed some light on escalation versus induction therapy.

Jason Freeman, MD, MBA: Dr Syed, there was information provided in the session, I understand, on non-traditional MS patient populations. Can you share your takeaways on that?

Arsalan Syed, PhD: Yes. Thanks for that question. In the session, it was highlighted that there is a need for having a higher diverse population in our clinical trials. Let me clarify what I mean by that. Diversity does not only mean different type of socioeconomic background. It also means different race and different comorbidities that a patient may have.

Jason Freeman, MD, MBA: How does that play into either the design of the trials or the clinical outcomes that we see as it relates to these factors?

Arsalan Syed, PhD: That becomes key, especially because you want to look at the efficacy of how it affects a patient. If a patient, let's say, is from a different race and has a comorbidity, let's say, of a cardiovascular disease. How will that drug affect [them] as opposed to someone who doesn't have any of this, and other than that, is completely fine, except that that person has MS? So that's what they really want to actually start teasing out.

Jason Freeman, MD, MBA: Can you share any information on NEDA, NEDA 3, or even PIRA that were discussed during the session?

Arsalan Syed, PhD: NEDA, or non-evidence of disease activity, was actually a topic which they focused on because what they mentioned is that it actually determines the efficacy of the DMT the patient is on. Now, as you're aware, NEDA 3 is looking at relapse activity, lesion activity, and disability progression. But you can also go to NEDA 4, 5, and 6, which will include brain volume, neurofilament, and cognitive impairment, respectively.

Jason Freeman, MD, MBA: And the purpose of sort of adding in NEDA 4, 5, and 6 to NEDA 3 is what?

Arsalan Syed, PhD: It's actually looking- it's increased sensitivity to the outcome. Increased reading, seeing how the HCP [health care practitioner], the test becomes more and more sensitive.

Jason Freeman, MD, MBA: The more data we have, essentially, about the patient the more sensitive outcome measures we're using, the better we're able to manage and make certain decisions.

Arsalan Syed, PhD: Exactly. Couldn't have said it better.

Jason Freeman, MD, MBA: Was there any new guidance provided from AAN with respect to either guidelines or other sort of treatment algorithms that can aid in either starting, stopping, or switching DMTs?

Arsalan Syed, PhD: The guidance actually was, there was no new guidance. They referred you back to the 2018 published work and encouraged the HCPs to refer to that.

Jason Freeman, MD, MBA: Overall this was a session on disease-modifying therapies, clinical outcomes, different populations, and multiple sclerosis. What are your key takeaways? What do we need to know about this session and about the information shared with them?

Arsalan Syed, PhD: The key takeaway for this session was that the HCPs who attended session were encouraged to refer to the AAN guidelines which were published in 2018. They also talked about NEDA as being a good measure for DMTs efficacy. Of course, the key highlight, which I think is important, is your diverse population in your clinical trials.

Jason Freeman, MD, MBA: Well, Dr Syed, thank you for your time today. We appreciate you being here and sharing your knowledge about this particular session.

Arsalan Syed, PhD: Absolute pleasure. Thank you so much.

Jason Freeman, MD, MBA: Thank you for watching AAN 2023 updates from Novartis US Medical Affairs.

Transcript Edited for Clarity