An expert provides the necessary steps needed to bolster accuracy of prescribed disease-modifying therapies for MS and do away with outdated trial-and-error approaches.
Le Hua, MD: I wouldn’t just limit this to siponimod (Mayzent; Novartis), but all of our therapies need to improve. We need to find a better way to figure out when that transition happens from purely a primarily inflammatory stage to just the leftover, underlying process. We know that starts from the very beginning, but we don’t have a good sense of what happens during that sweet spot of when patients transition.
The diagnostic accuracy of secondary progressive MS can take up to 2 to 3 years. As with everything, time is brain. The better we can accurately capture that transition point, the better we can target therapies. I do like the therapies that have a 2-compartment approach, having both peripheral inflammatory effects, as well as neurodegenerative effects because we know that neurodegeneration starts early on and continues as patients age. I do see in the future maybe having more neurodegenerative targets that might not necessarily have an anti-inflammatory component.
As the disease progresses, we should focus more on the actual processes that underlie neurodegeneration, with either reparative strategies, myelination strategies, or neuroprotective strategies.