New York Forum Tackles Unmet Needs in Multiple Sclerosis Care

On October 29, 2026, NeurologyLive convened a Clinical Forum in New York bringing together a close-knit group of MS specialists, neuro-ophthalmologists, and neuromuscular neurologists from across the New York and New Jersey area to discuss the shifting science and practice of multiple sclerosis (MS) care. The program, independently produced by NeurologyLive with support from Sanofi, was led by Mary Ann Piccone, MD, medical director of the MS Center at Holy Name Medical Center in Teaneck, New Jersey. “We’re all MS specialists,” Piccone told the group. “We all are in this because we love MS, we love our patients.”

Piccone opened with a look at MS epidemiology, including the strength of the link between Epstein-Barr virus and MS risk, before turning the conversation toward a broader question that would run through the evening: whether relapsing and progressive MS are better understood as separate entities or as one continuum, with disease activity shifting over time from peripheral, adaptive immune activity toward innate inflammation compartmentalized within the central nervous system. Live polling found that 73% of attendees favored the continuum model.

Much of the discussion centered on the limits of current high-efficacy therapies, particularly anti-CD20 agents. Attendees agreed the drugs have transformed relapse control, but several noted that patients can still accumulate disability independent of relapse activity, a phenomenon known as PIRA. “That is the natural course of the disease that we’re failing to control, even with high-efficacy therapies,” one attendee said, arguing that escalating treatment does not always address the biology driving a given patient’s decline.

Another compared starting a patient on a B-cell depleting therapy to a long-term commitment: “I say think of this as a 5 to 10 year plan. That’s really different than what we said to people 20 years ago, when we’d tell them, if we chose it right, you’re marrying the thing.” In a separate poll, 40% of attendees pointed to chronic microglial and macrophage activation as the likely driver of PIRA in patients on high-efficacy treatment.

That unmet need shaped the group’s interest in the pipeline. BTK inhibitors, CD19-directed CAR-T therapy, anti-CD40 blockade, and a more selective DHODH inhibitor all came up as candidates for reaching the compartmentalized, innate inflammation that current antibody therapies largely miss. Asked which strategy held the most promise for durably resetting that adaptive-innate interaction, 57% of attendees chose CAR-T therapy, though several cautioned that safety data, including deaths reported in a BTK inhibitor trial, remain a serious open question before any of these approaches reach practice.

The forum closed on a different unmet need: the gap between what physicians and patients each prioritize. Piccone cited the PERSIMS study comparing doctor and patient perspectives on MS-related quality of life, which found that patients ranked bladder dysfunction, vertigo, and visual impairment as bigger concerns than their physicians assumed. Live polling found that 62% of attendees do not formally use patient-reported outcome measures in routine visits, relying instead on informal conversation to track fatigue, cognition, and mood.

Asked for one takeaway to bring back to practice, attendees circled around two themes: humility and connection. “We’re one-percenters when it comes to MS,” one physician said, noting that most people with the disease are treated far from academic centers like the ones represented in the room. “I think we need to figure out how we can spread our abilities and knowledge more.” Others pointed to patient-reported outcomes as a concrete next step. “I don’t use PROs in any kind of systematic way,” one attendee admitted. “I think I probably should.” Piccone closed the evening by thanking the group, echoing a sentiment one attendee had offered moments earlier about why these forums matter: sitting at a table with colleagues who see things differently is “eye-opening, even if we don’t agree with each other.”