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Recent Update on the Oral Management of Relapsing Remitting Multiple Sclerosis (MS) - Episode 6

Emerging Therapies and Future Directions for RRMS

Heidi Crayton, MD, expresses her optimism for the future of multiple sclerosis and highlights emerging therapies and their impact on the care of patients with multiple sclerosis.

Heidi Crayton, MD: I think that we're all excited about the research that's going on in the MS [multiple sclerosis] world, because for a long time, not much was going on. We've had these big gaps in terms of unmet need and new products, and we have several different mechanisms of action that are in research right now, which is really exciting. We have 24 products on the market and we still have ongoing active research for better therapeutics. It is really exciting in this disease state. We have BTK [Bruton tyrosine kinase] inhibitors; there are several of those in the pipeline, and they're all a little different and will have different characteristics. The goal is to target that kind of smoldering MS—that underlying process—whatever that is that people who are more progressive still experience. We have EBV [Epstein-Barr virus], which has been in the press. Everybody's talking Epstein-Barr virus, not actually as a new player in the MS arena, but being able to target Epstein-Bar virus-laden cells and to target those cells is the most exciting future product for us to be kind of looking at. We are working on different mechanisms of action, which is very exciting. It brings a lot of hope for people with MS, and is just going to increase the armamentarium of what we have, and hopefully get us towards more personalized care and to be able to assess somebody's individual MS and their MS needs, and not have a start here, then go here, and then go here, but try to tailor therapies to that person's individual MS.

One thing that continues to frustrate me is that after 20 years of seeing data and talking about MS and the treatment of MS is that we still have this controversy over whether to start off treating people with high-efficacy therapies or not. This is still a bone of contention—something that we banter about—and there's no other area of medicine that has the same debate—to lose central nervous system tissue which doesn't have the ability to regenerate. It seems intuitive that we should do everything in our power to preserve what we have, so I don't believe in escalation therapy; I don't believe that we should be starting with lower-efficacy therapy so that we can sleep better at night. I don't sleep better at night if I'm not really treating people at the highest efficacy that their MS requires. Sometimes people say, “We don't really know what kind of MS a patient has, and we don't know if they have good or bad MS,” and that's not true. We have so much data on prognostic factors, and we know who's going to have a very poor prognosis and who's not. We need to do a better job in the real world, to use the data that we have, and to stop regurgitating the same data, but put that data to use and treat people to the highest efficacy. We have the tools to do that. Our goal should be that our patients are as unaware as possible of having MS.

Another thing that's exciting for those of us who work with patients with MS, in terms of personalizing care, is the future of biomarkers. We all struggle to know what product is the most beneficial, and if it's having benefit. Sometimes we don't have overt relapses that tell us that somebody is not responding well to therapy. MRIs are helpful, but there's a lot of expense that goes along with that. There's a big push for biomarkers to help give us guidance as to how people are benefiting from the therapies that we're using, and I think that'll be exciting and help us get closer to personalized medicine.

Transcript Edited for Clarity