The State of Multiple Sclerosis Therapy and Trends in Thinking: Robert K. Shin, MD

WATCH TIME: 5 minutes

“As we've seen at AAN and other meetings, data using different biomarkers, whether it's optical coherence tomography, serum neurofilament light, other biological markers, volumetric MRI, other more investigational MRI markers—what's the common theme? We're seeing that neurodegeneration occurs from the beginning of the disease process, if not probably before the patient's even aware or the providers are even aware of the diagnosis. I would say, rather than two different stages, we now see them almost as overlapping. We see that there is a progressive neurodegenerative component that is occurring, as best we can tell, probably from the beginning of the disease process that is punctuated by relapses.”

In the three decades since the first multiple sclerosis (MS) therapeutics were introduced in the 1990s, much progress has been made in developing effective and disease-modifying therapies (DMTs) for the disease. Now, even more novel approaches, such as those targeting Bruton tyrosine kinase (BTK) inhibition, or those with varied dosing options, are being explored to improve upon other aspects of disease management—particularly quality of life.

Despite this progress in improving treatments, though, many patients still utilize older drugs. Often, this can be related to their disease status, or to reduce the risk of unwanted adverse effects, or other reasons. Shared decision-making between patient and physician helps to result in a goal of treatment: optimization. That has also driven conversations about induction vs escalation strategies for the use of DMTs, and although the field appears to lean more toward induction—beginning with aggressive, high-efficacy treatment—a furthered understanding of the disease pathology has somewhat muddied the waters.

For Robert K. Shin, MD, professor of neurology, MedStar Georgetown University Hospital, the conversation about the state of treatment for MS is reflective of a shift in thinking from the field. In a conversation with NeurologyLive^®, he spoke about the changes in thinking that have occurred since the 1990s and what trends are appearing in the approach to disease management.