On World MS Day our neurology team are reflecting on the progress seen to date and looking ahead to some promising future developments.
Evolving management of MS
The last 20 years have seen significant progress, with the emergence of a wide range of highly effective DMTs for relapsing forms of MS substantially reducing the risk of relapses and slowing disability progression.
Attitudes to disease management have evolved from a treatment escalation approach to early use of high-efficacy DMTs and greater focus on sub-clinical forms of disease activity and progression independent of relapses. However, substantial unmet need still exists in progressive forms of MS where progress has been much more limited.
Promising treatments in development
While existing MS therapies are continuing to evolve with new dosages, formulations, and an increasing volume of real-world data in pregnancy, there are a number of interesting developments in the pipeline.
1. BTK inhibitors
Bruton’s tyrosine kinase (BTK) inhibitors are a new class of therapies being investigated for MS. Despite recent setbacks with concerns about liver toxicity and the failure of evobrutinib in phase III trials to reduce relapses vs Aubagio, there is still hope this class may have a beneficial impact on progression independent of relapses. As small molecules that are able to cross the blood-brain-barrier, BTKi’s may be able to directly target both microglia and B cells to potentially reduce neuroinflammatory processes within the CNS.
2. Anti-CD40L
Following a successful phase II trial, Frexalimab is now undergoing phase III trials in both relapsing MS and non-relapsing, secondary progressive MS. As a second generation anti-CD40L antibody, this novel, upstream mechanism may have the potential to address both acute and chronic neuroinflammation in MS, without causing lymphocyte depletion.
3. CAR T-Cell therapy
CAR T-Cell therapy, already revolutionary in cancer treatment, is being studied in MS. This approach involves genetically modifying a patient’s T-cells to target and destroy autoreactive immune cells that attack myelin. A phase II clinical trial is investigating the efficacy and safety of KYV-101 in patients with refractory, progressive forms of MS. KYV-101 is an autologous, fully human CD19-directed CAR T-cell therapy which with a single infusion, may readjust the immune system and potentially provide sustained disease control for those with refractory progressive MS.
Staying informed about these advancements and engaging with healthcare providers to assess the potential impact of these advancements is key to our neurology experts.
Reach out to the Beyond Blue neurology team to learn more about our experience in running over 50 global projects in MS.