NeuroVoices: Katrina Bawden, MSN, MSCN, FNP-C, on Emerging Therapies and Women’s Health Priorities in Multiple Sclerosis

Care for patients living with multiple sclerosis (MS) has continued to change in recent years, alongside developments in disease-modifying therapies, evolving because of considerations related to women’s health, and increased attention to individualized treatment approaches. Clinical management has increasingly reflected the heterogeneous nature of MS, with treatment decisions often varying based on disease course, patient characteristics, and life stage.

These shifts remain relevant in 2026 as clinicians assess how emerging research may influence patient care and future therapeutic options. In a new iteration of NeuroVoices, Katrina Bawden, MSN, MSCN, FNP-C, a certified MS nurse at Rocky Mountain MS Clinic, discussed several areas of interest for clinicians treating MS, including investigational therapies with novel mechanisms of action, such as Bruton tyrosine kinase (BTK) inhibitors and CAR T-cell therapy, which are being studied as potential options for certain patient populations.

During the conversation, Bawden also described changes in pregnancy management in MS, referencing clinic-based data examining outcomes among women with MS who continued natalizumab (Tysabri; Biogen) during pregnancy.¹ She additionally noted areas where evidence remains limited, including the effects of menopause on MS disease activity and the role of GLP-1 medications, emphasizing the need for further research to better inform clinical decision-making across different stages of women’s lives.

NeurologyLive: What emerging therapies or technologies, specifically in MS, are you most excited to see advance in 2026?

Katrina Bawden, MSN, MSCN, FNP-C: This one is a difficult question for me, and I think it’s a difficult question because I’ve worked with patients with MS since 2003, and there are many times we get really excited about something that’s going to come to market, or a new technology, and we’re all ready for it, and then it doesn’t end up happening. I do my best not to get overly excited about emerging technologies and therapies.

That being said, anytime there is a new mechanism of action with disease-modifying therapy to treat MS, that is exciting. MS is such a heterogeneous disease, and everybody’s MS is so different. What works for one person may not work for another, and what works for one patient in the early stages of the disease may not work for them in the later stages of the disease. Anytime we have something new and we can treat MS differently, that is exciting and hopeful for me.

To that end, I do hope that the BTK inhibitors end up coming to market. I know they’ve been delayed, some have been canceled, but it looks like the research may end up being promising, and I do hope that we find some way to get at least one of them to market so we have another option available to treat MS.

I’m also really excited about CAR T. I know CAR T is in the very early stages, and there are very few patients who have had CAR T up to this point who have MS, but thus far, the data looks promising. Again, anytime we have a new mechanism of action or a different way to go about treating MS and more options for patients, that’s a good and exciting thing. Those are probably the two things I’m most excited about this year.

What developments in MS do you anticipate will have the greatest impact on patient care this year?

MS affects people in their prime, and most often it affects women in their prime. One of the biggest developments and advances that we’re making is treating women during, before, and after pregnancy.

When I first started working at Rocky Mountain MS Clinic in 2008, the general rule of thumb was, don’t get pregnant. If you’re going to be on MS medicine, don’t get pregnant. Or the other rule of thumb was, if you’re going to get pregnant, don’t be on MS medication. It was heartbreaking. It was heartbreaking to see women have horrible relapses during pregnancy or horrible relapses after pregnancy and not really have many options.

As of late, starting about 2019, we really started to get momentum with, “Hey, we can probably treat these women while they have MS and remain on disease-modifying therapy, or dose disease-modifying therapies before they become pregnant. We don’t have to have this complete hands-off approach.” We received recommendations about B-cell therapy, that they can be dosed a couple months before pregnancy.

One thing I’ve been working on is natalizumab, specifically the use of natalizumab during pregnancy. Last year at the CMSC Annual Meeting, I presented my data. We did a retrospective analysis at our clinic looking at women who were exposed to natalizumab during pregnancy. We looked at the years 2008 to 2024. There were 58 pregnancies that were exposed to natalizumab during that time, and 20 women opted to stay on natalizumab during pregnancy.

We do follow the current guidelines that if you stay on natalizumab during pregnancy, we dose it every 8 weeks, with the last dose being around 32 to 34 weeks’ gestation. In the 20 women who remained on natalizumab during pregnancy, there were no relapses reported during pregnancy, and these women did remarkably well. Also, it helped prevent relapses during the postpartum period.

Adversely, of the 38 women that went off natalizumab during pregnancy, 17 out of 38, which is 45%, ended up having clinical or radiographic progression during pregnancy. In our clinic, we’ve been recommending that patients stay on natalizumab during pregnancy, unless they choose to go off, and then, that is their choice. We always want women to have that choice.

Since I presented that data in 2025, and I was looking at patients through 2024, anecdotally, at our clinic, we’ve had probably 5 to 10 more women remain on natalizumab during pregnancy, and we’re yet to see a relapse. It’s going remarkably well, and these women are doing well.

Because of that, there’s been some momentum, and now a group of us are working to put together a meta-analysis looking at broader use in the United States, use of natalizumab during pregnancy. We’re hoping that as we gather more information, it just gives us more knowledge and power to treat women throughout pregnancy and give them choice during pregnancy, in the postpartum period, and with breastfeeding as well.

Are there any unmet needs in MS, specifically in women, that you hope will be addressed?

A couple of things. The biggest one is menopause and MS. For years, we’ve said, “Oh, MS doesn’t change during menopause,” or “menopause doesn’t change during MS,” or vice versa, and we’ve just always treated symptomatically. I wonder if that is the case. I feel like that really is an unmet need that we need to look at more. Is MS different during menopause, and do we need to treat it differently during menopause? Do we need to treat it differently after menopause? I hope that we can look at this a little bit more.

Another one is the GLP-1 medications. These are gaining ground in overall medical use, and as we’ve had more and more patients with MS on GLP-1s, all I hear anecdotally is, “My gosh, I feel so much better.” You wonder, is there an anti-inflammatory effect? Is it because they’re eating less and they’re eating less inflammatory foods, so they feel better? Is it because they’re losing weight, so their joints hurt less? Is it because there is some type of anti-inflammatory effect on the MS itself? I feel like that is an unmet need where we have the resources available to look at that a little bit further, just to give us another option to help treat our patients with mMS in the best way we can.

Transcript edited for clarity. Click here to view more NeuroVoices.

REFERENCES
1. Bawden K, Riddle E, Menning K, Rutledge D, Christensen A, Foley J. LBA12 - Pregnancy and Natalizumab: A Single US Center Experience of 58 Pregnancies. Presented at: 2025 CMSC Annual Meeting; May 28-31. Phoenix, AZ. LBA12.