Treating All of MS: Unifying Strategies to Target Relapse and Progression in a Shifting Clinical Landscape

It is increasingly understood that multiple sclerosis (MS) relapse and progression can occur simultaneously, regardless of phenotype, revealing flaws in the traditional classification of MS and prompting increasing use of a spectrum-based view of the disease. This shift is reflected in updated diagnostic criteria and an ongoing shift to a spectrum-based view of MS, leading health care professionals (HCPs) to reconsider how MS is defined, monitored, and treated. In particular, this raises a key question as to whether relapse and progression should always be targeted simultaneously and what that means in a traditionally relapse-driven treatment armamentarium. With few available options to treat both relapse and progression, there is increasing interest in personalizing B-cell–targeting therapies to best meet the needs of patients. Further, with Bruton’s tyrosine kinase inhibitors (BTKis) beginning to see their first regulatory approvals around the world, it is important to understand how clinicians may leverage these tools within this spectrum-based approach to care.

In this EfficientCME live symposium, expert faculty will discuss the ongoing shift to a spectrum-based approach to MS and its implications; the individualization of currently available tools to address the concurrent management of relapse and progression; and the anticipated role and sequencing of emerging BTKis in the management of MS.

AGENDA

This symposium will center around core clinical questions facing the MS community today as the way we define MS evolves. As attendees, you will be asked to weigh in on these questions via polling to see where your colleagues stand and drive faculty discussion.

MODULE 1: The Evolving Understanding of MS and its Impact on Diagnosis and Monitoring

Core question: Can we eliminate MS phenotypes entirely.

• Ongoing shift from a phenotype-driven to a unified MS diagnosis
• Implications of the updated McDonald Criteria on the evolving concept of MS
• Ongoing questions and conflicting discussions

Core question: In a broadening arsenal of assessment tools, what will be the optimal combination to practically assess and monitor disease under a unified definition of MS?

• How to balance ideal biomarker use (e.g., PRLs, NfL, GFAP) with traditional measures and clinical realities (e.g., time, access, actionability) for monitoring the MS disease spectrum

MODULE 2: Are We Done Targeting Relapse on its Own?

Core question: With the understanding that MS often has simultaneous relapse and progression, should treatment strategies always target both (when possible)?

• What is the right amount of B-cell suppression? Can we maximize benefit and minimize potential adverse effects? Is there a cost to continuous treatment?
• Should we still target relapse in “non-relapsing” disease? Who is non-relapsing in the age of early HET?

MODULE 3: Integrating BTKis to Treat the MS Spectrum

Core question: Who is the best candidate for a BTKi?

• Theoretical vs observed benefits of BTKis
• Clinical implications of emerging data with fenebrutinib and initial regulatory approvals of tolebrutinib in the EU and UAE
• Quick case examples: Who is a good candidate? For which BTKi? Do biomarkers play a role?

Q&A 

At the conclusion of this activity, learners will be able to better:

• Analyze the role and impact of progression in relapsing disease and use this concept to frame clinical decision-making
• Incorporate currently available tools to enhance and individualize the simultaneous treatment of both relapse and progression
• Determine the role and sequencing of emerging BTKis to refine the spectrum approach to MS

Supported by an educational grant from Genentech, a member of the Roche Group.

MS specialists/neuroimmunologists, general neurologists, nurse practitioners (NPs), and physician associates (PAs) working in neurology settings

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Krieger reports the following financial relationships:

Consultant/Advisory Work: Biogen; Cycle Pharmaceuticals; EMD Serono; Genentech, Inc; MedRX; Novartis; PTC Therapeutics; TG Therapeutics, Inc.; and Zenas BioPharma, Inc.

Research Support: Biogen; Bristol-Myers Squibb; Novartis; and Sanofi-Genzyme

Speakers Bureau: Non-promotional speaking with Genentech, Inc and TG Therapeutics, Inc.

Dr. Granziera has no financial relationships to disclose

Dr. Freeman reports the following financial relationships:

Advisory Board: Amgen Inc; EMD Serono; Genentech, Inc.; Hoffmann La Roche; Immunic Therapeutics; Octave Bioscience, Inc.; Sanofi, and TG Therapeutics, Inc.

Consultant: Neurocast USA

Research Support: EMD Serono; Genentech, Inc.; MS Association of America; NIH/NINDS; Novartis; PCORI; Sanofi; and TG Therapeutics, Inc.

Other financial or material support: Participation in educational programs: Can Do Multiple Sclerosis; Medscape, Inc; and the MS Association of America

Speaking honoraria: Genentech; Merck & Co., Inc.; Octave Bioscience, Inc.; and Sanofi

The following individuals have no financial relationships to disclose:

Jeffrey Helfand, DO (Peer Reviewer)
Albert Eubanks, Jr., RN (Peer Reviewer)
Susan Perry (Planning Committee)
Lexie Oneca (Planning Committee)
Chloe Billings, MS (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

*All identified conflicts of interest have been mitigated.

Unlabeled Use Disclosure
Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CME Outfitters, LLC, the faculty, planners, and reviewers do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

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Call us at 877.CME.PROS (877.263.7767).

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