For more than 25 years Biogen has been a leader in the research and development of new medications for multiple sclerosis (MS).1 Our understanding of the disease has significantly evolved over this time, especially in diagnosis and treatment options. From the initial use of magnetic resonance imaging (MRI) technology to the introduction of disease-modifying therapies (DMTs), the landscape of MS care has changed dramatically. But what does the future hold?
MS Diagnosis Refinements
The diagnostic methodology for MS improved considerably with the introduction of the McDonald Criteria in 2001. These are a set of guidelines for clinicians that include MRI, laboratory and clinical evaluations to increase precision and allow for earlier detection and intervention.2
“As a clinician treating MS, I've personally seen how advancements in disease management have transformed patients' lives. The shift from subjective neurological assessments to precise MRI technology has drastically reduced diagnosis time, allowing us to offer more timely and effective treatments. Throughout my time seeing patients I was able to see firsthand how these changes brought hope and improved quality of life.” Guy Buckle, MD, MPH Medical Director for MS Clinical Development at Biogen.
Biomarkers are important in diagnosing MS and in monitoring disease progress. These biological indicators have the potential to reveal the presence of the disease before significant symptoms appear.3,4 Future developments could include new methods for the use of imaging technologies, including specialized brain scanning and a focus on precision mapping of myelin sheaths in the brain. Improvements to the MS diagnostic criteria will contribute to earlier diagnosis and efficient initiation of therapy.
Advancements in MS Treatment
The introduction of DMTs in the 1990s represented a significant advancement in providing therapies with clinically meaningful benefits to patients by reducing relapse rates and the likelihood of disability progression.5
Because existing treatments are unable to directly target abnormal cells in the central nervous system (CNS) (brain and spinal cord) that are thought to be driving disease progression and damage to neuronal tissue, research is focused on developing new therapies addressing this incapability together with improved benefit risk profiles. New imaging and fluid biomarkers being researched to improve diagnosis could improve disease progression monitoring and response to treatment.
“By effectively reaching the central nervous system, and targeting those cells that drive progressive biology we have the potential to fundamentally change how we manage and treat patients with MS. With careful molecule design considerations, we have increased confidence that we are developing molecules (both small molecules and antibodies) that will be able to engage these pathological cells at the site of disease activity in the CNS,” said Kelly Bales, PhD, Head of Multiple Sclerosis & Immunology and Genetic & Neurodevelopmental Diseases Research Units at Biogen.
Over the past twenty years, significant evolution of the diagnostic and treatment landscape in MS has been experienced. As the knowledge of the disease process has advanced so has the therapeutic approach, including the development of new therapies, novel modalities, and a unique potential to directly target processes withing the CNS at the site of greatest relevance.6 Within the next 10 years, the hope is for a truly personalized approach to treatment with multiple high efficacy treatments and varied mechanism of actions to treat different aspects of the disease resulting in the potential halting of progressive disease injury in MS patients. Looking even further afield, we may be able to reverse the abnormal immune process in MS to restore and protect nerve cells altering the clinical course of the disease.
Meeting Current Unmet Need
Management of progressive forms of MS is an area where there are crucial gaps in treatment options.7 By focusing on endpoints such as advanced imaging techniques and fluid biomarkers, we may enhance our ability to identify patients who are most likely to benefit from specific therapies. This refined approach not only helps to streamline the development of potential treatments but also helps ensure that we are effectively testing those interventions on individuals whose unique disease profiles align with the intended therapeutic effects. Ultimately, this effort may pave the way for more effective management strategies in progressive MS, aligning our research and clinical practices with the nuanced realities of the disease.
The Path Forward
The future of multiple sclerosis is filled with promise and potential. From advancements in diagnosis and treatment to the integration of AI and personalized medicine, there is a real possibility to transform MS care. By understanding the disease better, leveraging technological innovations, and amplifying patient voices, we can work towards a brighter future for those affected by MS.