Addressing the Unmet Needs of Managing MS Symptoms: Michael Y. Sy, MD, PhD

WATCH TIME: 3 minutes

"The big unmet need is disability progression. Some patients worsen despite optimal therapy, not showing new MRI lesions or experiencing relapses, highlighting a significant gap in our understanding and treatment of this aspect of multiple sclerosis."

In the field of multiple sclerosis (MS), a chronic inflammatory demyelinating and degenerative disease of the central nervous system (CNS), prevention of disability over the long term is the main treatment goal. Despite current therapies for MS reducing both relapses and relapse-associated worsening of disability, they are less effective at slowing disability accumulation.¹ In recent years though, Bruton tyrosine kinase (BTK) inhibitors and intracellular signaling molecules have been the latest MS treatment approaches tested since they affect the leading links of the disease pathogenesis and have the ability to pass through the blood-brain barrier.²

According to a recent review published in Nature Reviews Neurology, BTKs are involved in the regulation of maturation, survival, migration and activation of B cells and microglia.1 One selective oral BTK inhibitor, called evobrutinib (EMD Serono), recently met its primary end point in a phase 2 trial (NCT02975349) among patients with relapsing-remitting MS. In the trial, evobrutinib significantly reduced cumulative number of Gadolinium-enhancing lesions under the treatment compared with placebo. As it stands, researchers in the field are eagerly awaiting results of ongoing phase 2 and 3 studies with evobrutinib, and other BTKs in relapsing-remitting and progressive MS.³

At MSMilan 2023, the 9th Joint ECTRIMS-ACTRIMS meeting, held October 11–13, in Milan, Italy, Michael Y. Sy, MD, PhD, associate professor of clinical neurology at University of California, Irvine School of Medicine, sat down with NeurologyLive® to discuss the identified causes of disability progression in MS, and how BTK inhibitors offer promise in addressing this critical unmet need. In the quest for repairing disabilities in patients with MS, Sy talked about how far the field is from achieving true restoration, and the role that stem cell research plays in this endeavor. Beyond traditional pharmacological approaches, Sy also spoke about alternative modalities, including psychological interventions and integrative health strategies, that are being explored to meet the diverse needs of patients with MS.

Click here for more coverage of MSMilan 2023.

REFERENCES
1. Sharmin S, Bovis F, Malpas C, et al. Confirmed disability progression as a marker of permanent disability in multiple sclerosis. Eur J Neurol. 2022;29(8):2321-2334. doi:10.1111/ene.15406
2. Shulga O, Chabanova A, Kotsiuba O. Bruton's tyrosine kinase inhibitors in the treatment of multiple sclerosis. Postep Psychiatr Neurol. 2023;32(1):23-30. doi:10.5114/ppn.2023.126319
3. Steinmaurer A, Wimmer I, Berger T, Rommer PS, Sellner J. Bruton's Tyrosine Kinase Inhibition in the Treatment of Preclinical Models and Multiple Sclerosis. Curr Pharm Des. 2022;28(6):437-444. doi:10.2174/1381612827666210701152934