Biomarkers in Multiple Sclerosis

Jason Freeman, MD, MBA: Welcome to ACTRIMS 2023. I'm your host, Dr Jason Freeman, Medical Director, Novartis Medical Affairs, providing you updates from ACTRIMS 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.

Jason Freeman, MD, MBA: Joining us today from ACTRIMS is Dr Shelly Higgins, a Medical Science Liaison with Novartis Pharmaceuticals. Welcome, Shelly.

Shelly Higgins, PharmD: Thank you, Jason.

Jason Freeman, MD, MBA: We're here today to talk a little bit about biomarkers and some of the emphasis placed on biomarkers at this year's ACTRIMS. So, can you provide a summary of which biomarkers are being routinely used in MS and how they're actually being utilized in clinical practice?

Shelly Higgins, PharmD: Absolutely. There were lots of presentations, a lot of posters discussing biomarkers. It was a very hot topic. When we think about biomarkers, two actual traditional biomarkers come to mind, NfL as well as GFAP. NfL is probably the most recognized and most well-studied biomarker out there. We still are unsure with regard to how we're going to use it in clinical practice, what the actual clinical utility is going to be, and hopefully, more data will solidify what it is we're supposed to do. Next is GFAP. Still well-known but less frequently studied. So, more data in that arena is definitely welcome. So, of course, we have the MRI. Some say it's a biomarker, some say it's not, but we can't forget the utility of the MRI, as well.

Jason Freeman, MD, MBA: I hear there was a healthy debate at the conference this year.

Shelly Higgins, PharmD: There was a healthy debate.

Jason Freeman, MD, MBA: On that very topic.

Shelly Higgins, PharmD: Yes.

Jason Freeman, MD, MBA: In terms of NfL what are some of the challenges you see there in terms of either people accessing it or interpreting it?

Shelly Higgins, PharmD: So NfL has variability. It's a very ubiquitous biomarker. Age affects it, weight affects it. Many confounders to NfL. So, figuring out and evaluating biomarkers in an MS population can be challenging. So, identifying a true path with regard to NfL, how to measure it, when to measure it, how consistently to measure it is definitely something that we need to investigate.

Jason Freeman, MD, MBA: Moving on a little bit, how then do you see these biomarkers impacting clinical practice? I know that's to some degree limited but what might you see now and in the future in terms of patient management?

Shelly Higgins, PharmD: The more tools we have in our armamentarium, the better off we're going to be, the better off we're going to be able to treat our patients. So having these biomarkers available will help physicians determine how to move forward with these patients. Do I switch therapies? Do I investigate further with caregivers? Do we do additional physical tests to ensure lack of progression? Do we move forward with additional cognition monitoring? So, it's just another tool to help physicians make the right choice for their patients.

Jason Freeman, MD, MBA: Got it. So last question. What does the future hold? What do you see happening in the next 12, 24, 36 months with respect to the biomarker space?

Shelly Higgins, PharmD: A lot more data being generated for sure. That's a given. My crystal ball would be having a biomarker panel available, having individual biomarkers being available from a lab perspective, reference ranges being provided. What would be amazing would be can we look at all of these various biomarkers, put them together, and come up with, like, a disease activity score. That makes it easy, especially for the neurologists who really don't see a lot of MS patients. They need a little more help in guidance, evaluating, and interpreting these results.

Jason Freeman, MD, MBA: Thank you. It sounds like the future is bright. It's an exciting future and we look forward to what will become.

Shelly Higgins, PharmD: Thanks, Jason.

Jason Freeman, MD, MBA: Thank you for watching the ACTRIMS 2023 updates sponsored by Novartis. We look forward to seeing you at AAN 2023 for more exciting updates.

Transcript Edited for Clarity