The Importance of Addressing Unmet Treatment Needs in Smoldering MS: Antonio Scalfari, MD, PhD

WATCH TIME: 5 minutes

“We need the patients to be on board to report these type of symptoms because this is the starting point to eventually manage and target therapeutic interventions.”

Recent research has shown that progression independent of relapse activity (PIRA) initiates early in the relapsing-remitting phase of multiple sclerosis (MS), signifying that the disease operates on a biological continuum with overlapping pathological mechanisms from onset. However, studies also show that PIRA, often assessed through motor performance, may overlook more subtle symptoms in other clinical domains. These findings suggest a need to shift the current understanding of how central nervous system mechanisms contribute to the worsening of MS.

Further research has revealed that the gradual accumulation of disability in MS is driven by underlying smoldering processes, which remain an under-addressed therapeutic target. In a recent paper published in Annals of Neurology, a team of researchers introduced the concept of smoldering-associated-worsening (SAW), which includes both physical and cognitive symptoms.¹ The group of experts developed a consensus-based framework for recognizing smoldering MS and discussed potential biomarkers for tracking SAW. They also emphasized the importance of incorporating smoldering MS into future clinical practice and research.

One of the experts from the published consensus paper, lead author Antonio Scalfari, MD, PhD, a consultant neurologist at Imperial College Healthcare Trust and Northwest London Healthcare Trust, recently sat down with NeurologyLive^® in an interview to discuss how does smoldering MS differs from traditional views of relapsing and progressive forms of the disease. Scalfari, who also serves as an honorary senior clinical lecturer at Imperial College London, talked about why it crucial to motivate patients to report symptoms beyond inflammatory activity in MS treatment. Moreover, he spoke about the potential future changes in MS classification based on the understanding of smoldering disease.

REFERENCES
1. Scalfari A, Traboulsee A, Oh J, et al. Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol. Published online July 25, 2024. doi:10.1002/ana.27034