Using BTK Inhibitors in Clinical Practice for MS Management


Dr Hesham Abboud shares his opinion on the clinical practicalities of BTKi utilization in patients with multiple sclerosis.

Ahmed Obeidat, MD, PhD: Dr Abboud, thinking about BTK inhibitors again and thinking about the trials ongoing, and we mentioned they're relapsing in the progressive trials. What are you again most excited about for it? When we asked about the some of the things is once they are through the testing and then they get approved hopefully, we'll see if that's going to work out Where are you are going to be basing them in your treatment algorithm?

Hesham Abboud, MD: It's a great question. One of the most intriguing outcomes in most of the clinical trials that I'm seeing is confirmed disability improvement, which ties back to their potential impact on remyelination and the direct effect in the CNS itself. And if this particular secondary outcome turns out to be positive in some of these trials, their place in the algorithm of MS treatment will be on patients who already accumulated enough disability and if there's at least a premise that these medications might help in disability improvement, then this will be excellent candidates for this medication and that's why, for example, in our center, we wanted to do the second and progressive MS trial because they only select patients that are inactive, they don't have relapses anymore. And if this turns out to be positive, then we'll finally have something for a group of patients that we never had anything to offer them before, that's the most exciting part.

Ahmed Obeidat, MD, PhD: This is great. And I would say brightening and happy to think about confirmed disability improvement. That's something we don't think about too much, when we talk to our patients in the clinic, we say, well, hopefully we can prevent the relapses, hopefully we can prevent the new lesions and in progressive patients which we have hopefully we can slow down the progression. To say that we may be able to have some improvement, I think it's huge and this is where the field is moving. This is a lot of unmet need in MS, and we’re moving there. Now one of the things I want to also touch base on because the trials have been designed. Of course, we understand why they designed the trial and the way they designed the trial. But there's just a group of patients that typically are not included in the clinical trials. The ones who have an EDSS let's say of seven and above. Most of the trials go until 6.5, so those patients are mostly using a wheelchair for ambulation and just thinking about the EDSS, and those patients don't get to participate in these trials. Now if this molecule shows some good results for progressive MS, will you be offering this to those patients who are not part of the trial, but they also in need for treatment? They're really disabled from multiple sclerosis.

Hesham Abboud, MD: That's a great question some of us are already doing it. We know that in B cell depleting clinical trials, we've seen a slowing down of disability progression. We're also seeing in at least some of the trials, there was positive effect on confirmed disability improvement. And the way we think about it is there anything to salvage the cell for in this patient? Let's say someone is wheelchair bound, but they still have good use of their hands, or they still have excellent cognition. We can still try to predict that in slowing down disability progression by utilizing one of these medications that has at least that premise, again, as progression or neurodegeneration MS. If this class of medication turns out positive in the primary or the secondary progressive at clinical trials, we will be using them beyond the inclusion criteria of the clinical trial if the patient still has salvageable neurological function.And it would be even worthwhile to do a clinical trial and hire EDSS as a follow-up of these clinical trials were positive.

Transcript Edited for Clarity

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