The Expanding Role of Blood-Based Biomarkers in MS Care

Blood-based biomarkers are gaining attention as tools for assessing disease activity and informing clinical decision-making in multiple sclerosis (MS), potentially complementing established approaches such as clinical examinations and magnetic resonance imaging (MRI). As the field moves toward more biologically based approaches to understanding MS, these tests may help clinicians identify disease activity that is not readily apparent from symptoms alone and support more individualized treatment strategies.

At the 10th Joint ACTRIMS-ECTRIMS Meeting (MSToronto2026), held October 21-23, 2026, in Toronto, Ontario, Canada, blood-based biomarkers were among the topics discussed throughout the meeting. To gain further insight, NeurologyLive sat down with Terry Livingston, PharmD, vice president of medical affairs at Octave Bioscience, to discuss the evolving role of blood-based biomarkers in MS care.

Throughout the conversation, Livingston highlighted the potential applications of Octave’s MS Disease Activity (MSDA) test and the practical barriers that remain to broader implementation. She also discussed how future advances in biomarker research could help clinicians better predict disease activity and progression and move toward more personalized treatment approaches.

NeurologyLive: How is the role of blood-based biomarkers in MS care evolving, and what is driving their growing use in clinical practice?

Terrie Livingston, PharmD: What we’re seeing is a shift toward incorporating fluid biomarkers into clinical practice, not just research. There has been growing interest in moving toward more biologically based definitions of MS, with recommendations emphasizing a multimodal approach that includes fluid biomarkers. We’re seeing this shift take place in both research and clinical practice. The goal is to better understand the underlying biology of the disease and incorporate that information into clinical care.

What can blood-based biomarkers tell clinicians about a patient’s disease activity, and how can those results be used in practice?

With our MS Disease Activity test, we have a biomarker assay that measures 18 proteins. The test is designed to detect disease activity, allowing providers to gain insight into whether disease activity may be occurring in a patient who presents in the clinic. That information can help clinicians better understand what is happening with the disease and potentially inform decisions about how to manage the patient.

How could incorporating blood-based biomarkers into routine disease monitoring and treatment evaluation change the way clinicians manage patients with MS?

Currently, many patients are seen by their health care providers annually. Assessments of disease activity and progression are based on the clinical examination and MRI. MRI remains an important tool for detecting disease activity, but a blood test such as the MSDA test offers another way to assess what may be happening.

One potential advantage is the ability to identify subclinical disease activity, which may occur even when a patient is not experiencing obvious symptoms. If clinicians can detect that activity earlier, it could help them determine whether they need to take action more quickly.

The test provides an objective measure of disease activity that may offer additional insight when clinicians are considering treatment decisions, including whether to initiate or change a disease-modifying therapy (DMT). It may also have a role when evaluating acute symptoms, helping clinicians assess whether an episode could represent a true relapse or a pseudo-relapse. Ultimately, the opportunity is to identify disease activity earlier and give providers additional information to support their clinical judgment.

What are some of the main barriers to implementing blood-based biomarkers more broadly in routine MS care?

One barrier is reimbursement. Although some payers reimburse for these tests, coverage is not universal, so reimbursement remains an issue. There are also operational challenges, particularly around access to blood-draw services. Determining where a patient can go to have their blood drawn can be a significant obstacle.

We have a partnership with Quest Diagnostics, which has helped address some of these challenges. However, certain laboratories and health systems require patients to use specific laboratory providers.Some may use Quest, while others may require Labcorp, for example.

If a test does not have the necessary arrangements with a patient's preferred or required laboratory provider, that can make implementation more difficult. Addressing reimbursement and improving access to testing will be important as these tools become more integrated into clinical practice.

Looking ahead, where do you see the field of blood-based biomarkers in MS heading, and what developments are you most excited about?

I think the field is moving toward more targeted approaches and personalized medicine. In neurology and across neurodegenerative diseases, fluid biomarkers could help us better understand the underlying pathological drivers of disease.

That improved understanding could potentially lead to more personalized treatment for patients living with MS. We’re seeing a shift toward a more biologically based understanding of the disease, and the question is how that knowledge can translate into better treatments.

The concept of providing the right drug to the right patient at the right time is an important goal. Blood-based biomarkers could help facilitate that approach by providing additional information to guide treatment decisions.

What additional advances are needed to realize the full potential of blood-based biomarkers in MS?

There is still work to be done. One important next step would be establishing whether blood-based biomarkers can reliably predict future disease activity or progression. If we can use these biomarkers to identify which patients are at greater risk of experiencing disease activity or progression, that would be a significant step forward. It could help clinicians tailor care more effectively and move toward a more personalized approach to treatment. I think this is the next frontier in MS, and I’m excited to be part of it.

Transcript was edited for clarity. Click here for more ECTRIMS 2026 coverage.