Overview and Prevalence of Multiple Sclerosis (MS)

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EP: 1.Overview and Prevalence of Multiple Sclerosis (MS)

EP: 2.Treatment Selection in Multiple Sclerosis Management

EP: 3.Treatment Sequencing in Multiple Sclerosis

EP: 4.BTK Inhibitors in Multiple Sclerosis

EP: 5.Progressive Multiple Sclerosis and BTK Inhibitors

EP: 6.BTKi Safety Considerations in Multiple Sclerosis

EP: 7. Using BTK Inhibitors in Clinical Practice for MS Management

EP: 8.Unmet Needs in Multiple Sclerosis Clinical Trial Design

EP: 9.Role of Combination Therapy in Multiple Sclerosis

EP: 10.Impact of Route of MS Treatment Administration on Adherence

EP: 11.Future Thoughts on BTK Inhibitors in Multiple Sclerosis

EP: 12.Novel Mechanisms of Action for Multiple Sclerosis Treatment

EP: 13.The Future of Multiple Sclerosis Treatment

Ahmed Obeidat, MD, PhD: Hello, and Welcome to this Neurology Live® filming titled Multiple Sclerosis Treatments on the Horizon: BTK Inhibitors. I am Dr. Ahmed Obeidat from the American College of Wisconsin in Milwaukee, Wisconsin. Joining me today in this discussion are 2 of my colleagues. Dr Benjamin Greenberg is a Vice-Chair of Clinical and Translational Research at UT Southwestern Medical Center in Dallas, Texas. Dr Hesham Abboud is a Director of the Multiple Sclerosis and Neuroimmunology Program at University Hospitals Cleveland Medical Center and an Assistant Professor at the Case Western Reserve University in Cleveland, Ohio. Our conversation today will focus on ongoing studies with BTK Inhibitors and the role they have to play in the treatment of MS going forward. Welcome everyone. Let's get started. Dr Abboud, welcome. And Dr Greenberg, welcome. Today we will be talking about, BTK Inhibitors when we first start Dr Abboud, I'll start with you. And we want to talk about multiple sclerosis in general. Can you provide us with a brief introduction to MS and the prevalence of Multiple Sclerosis?

Hesham Abboud, MD: Multiple Sclerosis is an immune-mediated inflammatory and/or degenerative condition that affects the central nervous system. Recent estimates of the prevalence of MS in the United States is about 800 to 900 thousand patients, and this is probably underestimated. Most of the patients will have a relapsing remitting course. And then, if left untreated, about 80% of those patients will go into the secondary progressive phase of the disease. And then about 20% of the patients will start with a progressive course from the get-go and we call those primary progressive MS.

Ahmed Obeidat, MD, PhD: Thank you very much. Dr Greenberg, we have different classes of medications that we used to treat multiple sclerosis. They are numerous, right? Now, we talk about over 20 medications that we have available that are FDA approved. But they follow some different classes and they have distinct mechanism of actions. Can you please provide us with an overview of those medication that we use in regular basis on multiple sclerosis care?

Benjamin Greenberg, MD: I'm happy to. It's a great question because the field of MS has evolved so much over the last 20 years. I remember when I got started in this, meetings would focus on just 2 or 3 medications. And, as you said now, we have over 20 that we have at our disposal. And as we think about these medications, there are lots of ways to categorize them. Sometimes in the clinic when talking to patients, we talk about the root of administration. We explain to the patient an injectable, versus an oral, versus an infusion. But on the clinician side we tend to categorize them based on how they work for the disease. And in general, I like to use 3 different categorize to separate out the drugs. The first are immunomodulators, drugs that change the immune system without suppressing it. The second are immunosuppressant medications, those that lead to cell depletion and increase the risk of an infection or they change cellular trafficking enough to change the risk of infection, but somehow are suppressing the immune system. And then the third category are, what I refer to as, immune remodelers where you go in, you lead to cell depletion temporarily, and then you allow an immune system to grow back, but hopefully it grows back in a way that forgets the underlying autoimmunity of multiple sclerosis. These immune modulators, immunosuppressants, and immune remodelers are the three categories that we currently use in MS care.

Ahmed Obeidat, MD, PhD: Thank you very much. This is very helpful and a great overview.

Transcript Edited for Clarity