Examining the Role of a Novel Class of Medications for the Management of Multiple Sclerosis

Heidi Crayton, MD, and Maria Lopes, MD, discuss the impact of multiple sclerosis on patients, families, and caregivers, differentiate relapsing forms (relapsing-remitting and primary progressive) from non-relapsing forms (non-relapsing secondary progressive) in clinical practice, and highlight the key pathophysiological features of relapsing multiple sclerosis and the impact of progression independent of relapse activity (PIRA) after an initial demyelinating event.

Heidi Crayton, MD, and Maria Lopes, MD, discuss the limitations of using relapse rates as a critical endpoint in trials for patients with non-relapsing secondary progressive multiple sclerosis experiencing disease progression without relapse, explore methods to assess therapeutic benefit in this population, examine the relationship between cost of care and disease severity, and highlight the impact of decreased mobility and cognition on MS patients along with strategies for improvement.

Key opinion leaders discuss the most significant unmet needs in the current treatment landscape for multiple sclerosis.

Experts in multiple sclerosis discuss overall patient satisfaction with current disease-modifying therapies for multiple sclerosis, highlighting the need for more therapies that stave off decline and disease progression.

Heidi Crayton, MD, and Maria Lopes, MD, discuss the most recent 2018 guidelines for multiple sclerosis treatment, emphasizing the need for updated guidelines, particularly in the payer space, to ensure coverage criteria for MS medications, and they also consider the factors that influence their decision-making process when selecting therapies for patients with relapsing multiple sclerosis.

Experts in multiple sclerosis discuss the potential introduction of a subcutaneous form of ocrelizumab to the market in late 2024 and how they plan to incorporate it into their treatment algorithms.

Key opinion leaders discuss the challenges associated with step therapy requirements after initially selecting a drug class, the patient factors considered when deciding to switch a patient with non-relapsing secondary progressive multiple sclerosis to a different therapy, and whether payers commonly employ step therapy between different drug classes.

Heidi Crayton, MD, discusses the typical coverage criteria requirements she encounters from payers for currently-approved therapies for multiple sclerosis.

Heidi Crayton, MD, discusses the rationale for investigating Bruton tyrosine kinase inhibitors (BTKis) as a treatment for patients with multiple sclerosis and the current stage of development for evobrutinib, tolebrutinib, and other BTKis.

Medical experts discuss the failure of evobrutinib to meet its primary endpoint in phase 3 trials, review the primary outcomes of the phase 2B study of tolebrutinib in relapsing multiple sclerosis, examine payers' perspectives on the currently available data for tolebrutinib, and briefly describe the design of the HERCULES trial.

Key opinion leaders discuss the single FDA-approved option for primary progressive multiple sclerosis and emerging therapies under investigation for this MS subtype, examine the PERSEUS trial, and address concerns they anticipate with the potential approval of BTKis for MS patients and strategies for mitigating these concerns.

Heidi Crayton, MD, and Maria Lopes, MD, discuss future research in multiple sclerosis that they find exciting and promising.