Commentary
Video
Key Insights from ACTRIMS Forum 2025: Diagnostic Criteria, Imaging, and MS Subtypes
Experts discussed recent advancements in diagnostic criteria, imaging techniques, and the evolving understanding of multiple sclerosis subtypes and treatment responses. [WATCH TIME: 10 minutes]
WATCH TIME: 10 minutes
The 2025 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum, held February 27 to March 1, in West Palm Beach, Florida. This CE-accredited meeting featured a single track of scientific and clinical presentations focused on advancing research and treatment for multiple sclerosis (MS) and related disorders. The 2025 theme, "Making Connections," emphasized linking aging to MS pathology, exploring cross-disorder and neuroanatomical connections, bridging data with clinical application, and investigating brain repair and protection. Designed for researchers, clinicians, students, and fellows, the ACTRIMS Forum provided opportunities to engage with experts, optimize MS management, and explore emerging concepts in neuroimmunology.
In collaboration with Cleveland Clinic, NeurologyLive® held a roundtable discussion with MS experts who talked about key advancements in MS treatment and research that were discussed during the 2025 ACTRIMS Forum. The experts shared their thoughts on which sessions from the Forum that could have the most immediate impact on clinical practice and examined how emerging therapies could transform MS treatment in the coming years. They also explored the role of AI and machine learning in MS as well as the increasing focus on aging and MS progression. The panelists in this conversation included neuroimmunologist Moein Amin, MD, neurologist Marisa McGinley, DO, and neurologist Devon Conway, MD, from Cleveland Clinic.
In this first episode, experts shared valuable insights into how evolving diagnostic criteria and imaging tools can potentially reshape clinical practice for MS. Key discussions at the Forum focused on the potential impact of the new diagnostic criteria, including the integration of the central vein sign (CVS), and its ability to diagnose MS earlier, which could lead to more timely treatment. Other topics presented included the role of paramagnetic rim lesions (PRLs) in assessing treatment effects and the debate over whether MS should be considered as distinct subtypes or a single disease. These discussions held at the Forum highlighted the possible need for advanced biomarkers and imaging techniques in MS diagnosis and management.
Transcript edited for clarity.
Isabella Ciccone, MPH: The first question I have here is based on the ACTRIMS Forum that was recently held. Which session from the agenda do you think will have the most immediate impact on clinical practice and why? There’s just been a lot of discussion, from the new criteria to innovations and AI. So, does anybody want to talk about what they feel has an impact on care here?
Marisa McGinley, DO: I mean, I can start us off, if that's okay. I think ACTRIMS is a really interesting conference because it really spans from in-the-lab, basic research all the way to what can affect clinical care. And so, we’re always trying to pull out those pearls, like, "What can we take back to our clinic today?" Because a lot of the meeting is still in that development phase, and it’s one of the next steps in the field. But I do think there were a couple of very pertinent clinical pearls about what we can change in practice right now. And as you already alluded to, I think it really is more around diagnosis.
For me, one of the best sessions at ACTRIMS is typically the late-breaking session or the one on clinical trials because that's sort of the closest to our clinics. I think there were 2 talks in that session that really stood out to me. The first one was presented by Jiwon Oh, MD, PhD, on the tolebrutinib (Sanofi) study, specifically looking at PRLs (paramagnetic rim lesions). I found it really interesting because, obviously, the Bruton tyrosine kinase (BTK) inhibitors are at the forefront of many clinicians' minds right now as we’re awaiting to see, "Is this something we’re going to start implementing in clinical practice?" A big question around its use is patient selection, which is always something we think about with disease-modifying therapies. But as we start to think about progressive treatments, it gets a little trickier because it’s not necessarily a one-size-fits-all approach. Oh’s presentation looked at the proportion of PRLs in the tolabrutinib study participants. My interpretation was that patients with more of these lesions seemed to show a greater treatment effect. So it’s an interesting concept: is this something we could use more in clinical practice to potentially monitor treatment effects, use it more in trials, and think about it as an outcome we’re monitoring? It’s not something we’re currently using day-to-day, but it’s something we could integrate into practice. That was really interesting.
Along the same lines, still in an imaging vein, I know Amin has a lot to say about this, was the last session on the use of the new diagnostic criteria, specifically looking at the CAVS-MS data and patients who wouldn’t have met the diagnostic criteria yet. This session explored how the integration of the CVS changes the ability to diagnose patients. I think the key takeaway here was that, with these new diagnostic criteria using the CVS, almost a third of patients would actually have met the diagnostic criteria. For us as clinicians, that’s really exciting because it means that the use of central vein will shift how we think about diagnosis and gives us another tool. We’re always looking for ways to diagnose patients sooner so they can start treatment when we know it’s most effective. I thought that session showed us that we should be integrating these MRI metrics into clinical practice more, both from a treatment response and a diagnosis standpoint. But I don’t know, that was my favorite session. I’m curious if the others were in that one or had any other sessions they really enjoyed.
Moein Amin, MD: Yeah, I agree with you on the late-breaking abstract sessions. The last session, looking at the application of the new proposed diagnostic criteria for patients who wouldn’t have otherwise met the diagnostic criteria for multiple sclerosis, is going to help us clarify diagnoses for that group of patients. As clinicians, we all want to help them and get them a clear diagnosis, but there are limitations with the current diagnostic criteria. So, I think we’re all eagerly waiting for the new criteria to be released later this year so we can start applying it in clinical practice, more widely across the U.S.
For myself, one other session that I thought had an immediate clinical application—though it may not be something you see day-to-day—was the debate on whether we think there are truly different subtypes of multiple sclerosis or if MS is just one disease as a whole. It’s fascinating to hear both sides of the argument. Many times, we have patients ask us in the clinic, “What kind of MS do I have? Is it relapsing-remitting? Is it primary progressive? Is it secondary progressive?” and it’s always difficult to answer those questions because MS is a very dynamic disease and it varies from person to person.
It’s interesting to hear both sides of the argument—while there are common upstream effects and shared genetic factors across all MS pathophysiology, there are also a lot of similar immunopathological abnormalities. However, specifically with machine learning, some of these approaches are being applied to identify clusters and subgroups of MS presentations that go beyond just using MRI or clinical data to categorize someone as primary progressive or relapsing-remitting MS. There’s potential to use more advanced biomarkers to identify different stages of the disease, which may shift over time but could give us additional prognostic information regarding a patient’s response to treatment. I thought that was an interesting discussion as well.
Devon Conway, MD: I’ll try to wrap up. With ACTRIMS, it’s always very basic science-heavy, so sometimes it’s hard to find things that will have an immediate impact in the clinic. But one thing I thought was interesting from the basic science perspective was a talk on CAR T. Not so much for treatment, which we’re all excited about, but using CAR T to induce demyelinating disease in animals for animal models. They created CAR T-cells targeting the MOG protein. I think the idea that we might be able to create animal models that more closely mimic MS is exciting. The better our animal models are, the faster we can hopefully move treatment candidates from the lab to human testing. While it may still take a few years, getting those candidate molecules through the lab stage faster will be helpful in promoting new treatments and potentially discovering new mechanisms of action to address some of the more difficult-to-treat aspects of MS, like progression.
