Multiple Sclerosis

Posted on Multiple Sclerosis

Study finds some Multiple Sclerosis therapies may not slow disability progression

In people with primary progressive multiple sclerosis (MS), a new study has found no difference in the amount of time before disability worsened between people taking certain medications and those not receiving treatment. The study is published in the September 25, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. With MS, the body’s immune system attacks myelin, the fatty, white substance that insulates and protects the nerves. People with primary progressive MS experience a steady decline in symptoms. About 10 to 15% of people with the disease have this type of MS. The study looked at rituximab and ocrelizumab, anti-CD20 infusion therapies that target a protein called CD20 found on some white blood cells called B-cells. Removing these cells from the bloodstream is believed to reduce inflammation and damage that can occur to the myelin. Ocrelizumab is approved by the U.S. Food and Drug Administration (FDA) for primary progressive MS and for people with relapses, but rituximab is not. Rituximab is FDA approved for other diseases like rheumatoid arthritis and prescribed off label for MS. “MS is a disabling disease, so treatments that slow the progression to worse disability are sorely needed,” said study author Laure Michel, MD, PhD, of Rennes University in France. “Anti-CD20 therapies are widely prescribed, in part because there are few alternate treatments. However, our study suggests they may not slow disability from worsening for people with primary progressive MS.” The study involved 1,184 people with primary progressive MS who had an average age of 56. They did not take MS medications in the two years prior to the study. For the study, 295 people were treated with rituximab, 131 were treated with ocrelizumab and 728 were untreated. They were followed for an average of four years. Participants’ level of disability was measured on a scale with scores ranging from zero, meaning no symptoms, to 10 points, meaning death due to MS. At the start of the study, all participants had a score of 6.5 or less. Researchers then measured how long it took for people to advance to their first confirmed disability progression. For those whose score was less than 5.5 at the start of the study, advancing one point on the scale was considered progressing in disability. If their score was 5.5 or more, advancing 0.5 points on the scale was disability progression. After adjusting for possible differences between the treated and untreated groups, researchers found there was no difference in the time it took to progress to the next level of disability between those taking a medication and those taking no medication. “Medications for MS can be expensive and come with risks of side effects,” said Michel. “Our results indicate that there should be a constant evaluation of MS therapies to determine if the benefits outweigh the risks for people with primary progressive MS.” A limitation of the study is that it was a look back in time and did not follow people in real time. Also, among those taking medications, most were taking rituximab with fewer people taking ocrelizumab. More research is needed in larger groups of people to confirm the findings.
In people with primary progressive multiple sclerosis (MS), a new study has found no difference in the amount of time before disability worsened between people taking certain medications and those not receiving treatment.


With MS, the body’s immune system attacks myelin, the fatty, white substance that insulates and protects the nerves. People with primary progressive MS experience a steady decline in symptoms. About 10 to 15% of people with the disease have this type of MS. The study looked at rituximab and ocrelizumab, anti-CD20 infusion therapies that target a protein called CD20 found on some white blood cells called B-cells. Removing these cells from the bloodstream is believed to reduce inflammation and damage to the myelin.

Ocrelizumab is approved by the U.S. Food and Drug Administration (FDA) for primary progressive MS and people with relapses, but rituximab is not. Rituximab is FDA-approved for other diseases like rheumatoid arthritis and prescribed off-label for MS. “MS is a disabling disease, so treatments that slow the progression to worse disability are sorely needed,” said study author Laure Michel, MD, PhD, of Rennes University in France. “Anti-CD20 therapies are widely prescribed, partly because there are few alternate treatments. However, our study suggests they may not slow disability from worsening for people with primary progressive MS.”


The study involved 1,184 people with primary progressive MS who had an average age of 56. They did not take MS medications in the two years prior to the study. For the study, 295 people were treated with rituximab, 131 were treated with ocrelizumab and 728 were untreated. They were followed for an average of four years. Participants’ level of disability was measured on a scale with scores ranging from zero, meaning no symptoms, to 10 points, meaning death due to MS. At the start of the study, all participants had a score of 6.5 or less. Researchers then measured how long it took for people to advance to their first confirmed disability progression. For those whose score was less than 5.5 at the start of the study, advancing one point on the scale was considered progressing in disability. If their score was 5.5 or more, advancing 0.5 points on the scale was disability progression.

After adjusting for possible differences between the treated and untreated groups, researchers found there was no difference in the time it took to progress to the next level of disability between those taking a medication and those taking no medication. “Medications for MS can be expensive and come with risks of side effects,” said Michel. “Our results indicate that there should be a constant evaluation of MS therapies to determine if the benefits outweigh the risks for people with primary progressive MS.” A limitation of the study is that it was a look back in time and did not follow people in real time. Also, among those taking medications, most were taking rituximab with fewer people taking ocrelizumab. More research is needed in larger groups of people to confirm the findings.

Posted on Multiple Sclerosis

Tolebrutinib Research Data (New Multiple Sclerosis Drug)

This video reviews phase III clinical trial results on tolebrutinib presented at ECTRIMS. The GEMINI trials studied tolebrutinib vs. aubagio in relapsing MS, and the HERCULES trial studied tolebrutinib vs. placebo in progressive MS.

Posted on Disability, Multiple Sclerosis

Multiple sclerosis -key biomarkers that predict disability discovered

A pioneering study presented today at ECTRIMS 2024 has identified critical biomarkers that can predict disability worsening in multiple sclerosis
A pioneering study presented has identified critical biomarkers that can predict disability worsening in multiple sclerosis.


His breakthrough research can potentially transform treatment strategies for millions of MS patients worldwide, paving the way for more personalised and effective treatment plans.

In a multicenter observational study conducted across 13 hospitals in Spain and Italy, Dr. Enric Monreal and his team discovered that elevated serum neurofilament light chain (sNfL) levels, a protein indicating nerve cell damage at the onset of MS, can predict both relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA). Furthermore, they found that serum glial fibrillary acidic protein (sGFAP) levels, a protein derived from astrocytes that enter the bloodstream when the central nervous system (CNS) is injured or inflamed, correlate with PIRA in patients with low levels of safety.

Key findings reveal that higher sNfL levels, indicative of acute inflammation within the CNS in MS, are associated with a 45% increased risk of RAW and a 43% increased risk of PIRA. Patients with high sNfL levels often did not respond well to standard disease-modifying treatments (DMTs) but showed significant benefits from high-efficacy DMTs (HE-DMTs) such as Natalizumab, Alemtuzumab, Ocrelizumab, Rituximab, and Ofatumumab.

In contrast, patients with high sGFAP levels—which indicate more localised inflammation driven by microglia in the CNS—and low sNfL levels experienced an 86% increased risk of PIRA. This group did not respond to current DMTs.

Interestingly, while sGFAP is known to be associated with progression, high sNfL levels limited the ability of sGFAP to predict this outcome. Specifically, sGFAP values were predictive of PIRA only in patients with low sNfL levels.“”The discovery of sNfL and sGFAP as predictive biomarkers enables us to customize treatment plans for MS patients more effectively,” says Dr. Monreal, a researcher in MS at Ramón y Cajal University Hospital and the study’s lead author. “Patients with low levels of both biomarkers have a positive prognosis and can be treated with injectable or oral DMTs. However, high sNfL levels indicate a need for HE-DMTs to prevent disability progression, while patients with high sGFAP levels and low sNfL values may require new therapeutic approaches. These distinct pathways in MS have significant therapeutic implications, as current DMTs primarily target the peripheral adaptive immune system without affecting CNS immunity. Therefore, identifying patients with higher levels of peripheral inflammation is crucial for preventing disability and improving patient outcomes.”

“The results of this study underscore the critical need for personalised treatment approaches to effectively manage the millions of people affected by MS worldwide, many of whom have chronic disability that significantly impacts their quality of life,” says Dr. Monreal.

“By measuring both sNfL and sGFAP levels at disease onset, we gain valuable insights into the progression pathways of MS, enabling clinicians to identify the optimal patients for specific DMTs. This approach aims to prevent disability while avoiding unnecessary treatment-related risks for those at lower risk.”
Posted on Multiple Sclerosis, Women's Health

New study uncovers therapeutic inertia in the treatment of women with multiple sclerosis

A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.
A study has revealed significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), highlighting gender disparities that could impact long-term health outcomes for women of childbearing age.

The findings suggest that concerns related to pregnancy may result in delayed or reduced use of disease-modifying treatments (DMTs), even before pregnancy is considered.

The study also found that the difference in treatment became apparent after two years of disease duration for DMTs and as early as one year for HEDMTs. Notably, this gender-based treatment gap did not significantly change with patient age, suggesting that therapeutic inertia could persist regardless of the woman’s stage in life.

“These findings emphasize the crucial need to reconsider how we make treatment decisions for women with MS, especially those of childbearing age,” says Professor Sandra Vukusic, the lead author of the study. “Women may not be receiving the most effective therapies at the optimal time, often due to concerns about pregnancy risks that may never materialize. The use of Disease-Modifying Therapies (DMTs) and Highly Effective Disease-Modifying Therapies (HEDMTs) is frequently limited by potential and unknown risks associated with pregnancy, as there is often insufficient data available when these drugs first come to market.”

Both neurologists and patients contribute to therapeutic inertia, with many adopting a cautious approach and avoiding these treatments. “Neurologists may be reluctant to prescribe DMTs, especially if they are not comfortable managing pregnancy-related issues,” explains Professor Vukusic. “At the same time, women understandably do not want to take any risks for their child or pregnancy. Their primary concerns are congenital malformations, fetal loss, and fetal growth disorders. Women will also feel uncomfortable if their neurologist appears uncertain.”

Moving forward, the research team plans to further investigate the factors contributing to therapeutic inertia. They aim to improve treatment strategies prioritizing the long-term health of women with MS and their reproductive goals.

“The main impact of this inertia is the less effective control of disease activity during DMT-free periods, leading to the accumulation of lesions and an increased risk of long-term disability,” emphasizes Professor Vukusic. “This represents a real loss of opportunity for women, especially in an era where DMTs are so effective when used early.”

Posted on Multiple Sclerosis

Multiple Sclerosis and Falling: Advice from a MS Specialist Neurologist

“Falling is a common symptom of MS. This video will discuss the causes of falling in MS patients, including muscle weakness, spasticity, incoordination, vision, and cognitive problems. We will also explore the importance of early detection and treatment and the role of physical therapy and other interventions in preventing falls.”