Identifying and Treating Progression in MS Beyond Relapses: Celia Oreja-Guevara, MD, PhD

WATCH TIME: 6 minutes

"We need to detect this silent progression that is part of the smoldering disease, and at the same time we need to treat this progression, because it is doing the major disability of the patients."

At the 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 28-31, 2025, in Phoenix, Arizona, a symposium titled "BTKi Update: Breaking Through the Blood-Brain Barrier & Transforming Smoldering Disease as a Driver of Disability" offered a comprehensive look at the evolving role of Bruton’s tyrosine kinase inhibitors (BTKis) in multiple sclerosis (MS). Chaired by Robert J. Fox, MD, FAAN, the session began with Celia Oreja-Guevara, MD, PhD, outlining the urgent need to better monitor and manage disability accumulation in MS, particularly progression independent of relapse activity.

Following Oreja-Guevara ‘s presentation, Fox then delved into the mechanistic rationale behind BTK inhibition, highlighting its ability to modulate smoldering neuroinflammation in the CNS. Additionally, Anthony L. Traboulsee, MD, FRCP, provided practical clinical insights, bridging the gap between emerging science and real-world applications. The session concluded with a panel discussion with the speakers focused on clinical strategies and future opportunities for targeting progression and disability in MS through BTKi-based therapies.

During the meeting, Oreja-Guevara, vice chair of neurology at the Hospital Clínico San Carlos in Madrid, sat down with NeurologyLive^® to discuss the clinical shift in MS care from managing relapses to addressing disease progression, especially progression independent of relapses. In the discussion, she emphasized the limitations of the EDSS scale in capturing early signs of worsening and advocated for the use of alternative functional assessments, patient-reported outcomes, advanced MRI markers like slowly expanding lesions, and blood biomarkers such as GFAP. These tools, she suggested, may enable earlier detection and intervention when new treatment options, such as BTK inhibitors, become available.

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REFERENCES
1. Oreja-Guevara C. Monitoring & Managing Disability Accumulation: Addressing an Unmet Need. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, AZ. Independently Supported Symposium 3.