Decera Clinical Education Neuroscience Podcast · Decera Clinical Education

What’s Next in MS Care: Guidelines & Pipeline

·22 min·5 clips

Dr. Patricia Quill joins the program. She and host Tadani revisit the 2018 AAN disease-modifying therapy guidance and the practical problem of depending on recommendations that are not refreshed regularly. The focus stays clinical. From there, the discussion turns to how clinicians choose therapy for MS when relapse control, disability, and progression do not line up neatly, and why a higher-efficacy agent may be needed instead of yet another incremental step. Progression matters. Quill explains that the field still needs better ways to detect progression itself, because progression independent of relapse activity can shape treatment decisions even when focal inflammatory disease seems quiet. The pipeline comes next. BTK inhibitors take up much of that section, described as oral agents being studied for relapsing MS and progressive MS, with CNS penetration that could let them act on microglia and B cells inside the central nervous system as well as on peripheral B cells and monocyte macrophages. The names stack up. She walks through evobrutinib, tolobrutinib, phenobrutinib, remabrutinib, orelobrutinib, and BIIB091, noting completed phase III relapsing studies, ongoing relapsing trials, planned progressive trials, and a small combination study with dimethylfumarate. Use cases stay practical. The discussion then weighs three broad ways a BTK inhibitor might fit into care: as monotherapy for MS, especially when progression is prominent; as follow-on treatment after a high-efficacy relapsing phase has done its job; or as combination therapy aimed at both inflammatory and progressive biology. The evidence is still being sorted out. Quill treats the relapsing-phase evobrutinib results as part of an unfinished story, which keeps the class interesting but not settled. That restraint helps. Rather than overselling any single molecule, the episode treats the entire class as a work in progress and keeps returning to the same clinical problem: how to match drugs to disease behavior when the disease is changing under your feet. Repair stays on the table. The closing stretch broadens the lens to CNS repair strategies, which are presented as a major research need not only for MS but for other major neurologic disorders and neurologic insults where fixed deficit still limits recovery. The tone remains measured. By the end, the conversation has become a compact briefing on guidelines, progression, emerging oral therapies, and the limits of current evidence, delivered in the steady, teaching-oriented style the show uses when it wants clinicians to think carefully rather than quickly.

As heard by us

A careful map of MS care, from 2018 guidance to the pipeline's focus on progression.

It frames multiple sclerosis care as a field where guidance often trails day-to-day practice, and where the next wave of therapies is still being defined. Dr.

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You want the clearest path from older MS guidelines to what is next in care.

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