Ryan Haumschild, PharmD, MS, MBA: Hello and welcome to this AJMC® Peer Exchange program titled, “Bruton Tyrosine Kinase Inhibitors in Patients With Multiple Sclerosis.”I am Dr Ryan Haumschild, director of pharmacy services at Emory Healthcare and the Winship Cancer Institute [Atlanta, Georgia]. Joining me today in this discussion are my colleagues, Amanda Hickman, central support pharmacist for neurology, psychiatry, and sleep disorders at Trellis Rx [Atlanta, Georgia]; Dana McCormick, director of pharmacy, Blue Cross and Blue Shield of Texas [Richardson, Texas]; Mitzi Joi Williams, board-certified neurologist and founder of Joi Life Wellness [Smyrna, Georgia]; and Amanda Montague, chief mission officer of the Multiple Sclerosis Association of America [Seattle, Washington].

Today, our panel of experts will explore the treatment landscape and impact of multiple sclerosis [MS], unmet needs to help patients with MS, and the emerging role of Bruton tyrosine kinase [BTK] inhibitors in MS. Thank you, and let’s begin.

As we start talking about MS, I think it’s important to focus on the epidemiology, some of the clinical presentations, and the classification of MS. Let’s start with you, Dr Williams, can you give us a brief overview of MS in its epidemiology?

Mitzi Joi Williams, MD FAAN: Absolutely. MS is considered an autoimmune disease, meaning the immune system gets confused, so to speak, and attacks a normal part of the body. The myelin, or coating of the nerves, in the central nervous system is a target of attack with MS. The damage to myelin can result in a variety of symptoms, ranging from visual loss to numbness and tingling, weakness on one side of the body, difficulty walking, etc. It’s a disease primarily of young people. People are diagnosed between ages 20 and 40, and often it’s progressive. That’s why it’s important for us to try to treat and attack this disease early to prevent long-term progression.

Ryan Haumschild, PharmD, MS, MBA: Excellent, you nailed it. MS requires unique treatment, with long-term progression being the focus. When we think about it, we think of it from a treatment perspective, but what about the patient journey? Amanda, in your experience, how has the journey for patients with MS changed over the last decade?

Amanda Montague, Ed.M.: The No. 1 thing I would say is that the treatment landscape has exploded. It’s been a wonderful time for those living with MS and for clinicians because there are so many more tools in the arsenal, if you will, for how to treat and try to stop the progression of MS. There’s also been more of a focus on a comprehensive approach of treating MS, which has been wonderful because there are a lot of symptoms that go along with MS. It’s not just disease-modifying therapies that are important, but also incorporating health and wellness and other aspects of trying to create a good quality of life for those living with MS. That approach has been wonderful too for the MS community.

Ryan Haumschild, PharmD, MS, MBA: I think you nailed it. We have to think about treatment outcomes and how we evaluate the clinical efficacy across different trials, while thinking about quality of life, activities of daily living, key indicators of how well that patient is going to be on treatment, and ultimately through that continuum of care. I appreciate you highlighting that. As we start to transition now toward the different classifications of MS, we know that not every patient is the same, especially in their treatment journey. Dr Hickman, I want to turn to you right now. If you could, please review the classification of MS per the guidelines set by the American Academy of Neurology and what their different classifications are.

Amanda Hickman, PharmD, MPH, MSCS: Yes. It’s a wonderful time to be in neurology, I would think, because we’re learning so much, especially about the disease state of MS. In my opinion, words are powerful. Knowing what type they have helps us determine what their prognosis is going to be and what treatments are available to them. The first 3 types I like to think of as the patient’s lifetime journey include CIS, or clinically isolated syndrome, where not all the diagnostic criteria are there yet, but it’s very suspicious for MS. Recommendations now are to go ahead and get those patients started on treatment.

The majority of patients are diagnosed with relapsing-remitting MS, or RRMS. That’s the predominant type. Basically, they have phases of very active MS, and phases of going into remission and not a lot of activity. As the patient has that, it can transition into secondary progressive MS, which is where the nervous system has been under fire for quite a while. It starts steadily declining as the patient has aged, and they may not have those loud relapses anymore, but they do have a steady clinical decline and increase in disability. The last one, primary progressive MS, is basically where patients from the start don’t have those very obvious relapses, but they do have a steady decline in disability. Unfortunately, this is the most difficult type of MS to treat right now.

Ryan Haumschild, PharmD, MS, MBA: Excellent. I appreciate you reviewing that and even giving a bit of context in terms of where are the therapeutic innovations occurring and where is the biggest unmet need. I think that benefit will help drive our discussion today.

Transcript edited for clarity.