More targeted, higher efficacious medications can drastically reduce the risk for accruing disability in newly diagnosed patients with MS.
At the 2023 Fall Conference of The American Academy of Neurology Institute (AAN), Kristi Epstein, APRN-CNP, delivered a presentation titled, “Applied Neuropharmacology in Clinical Practice: Multiple Sclerosis.” The presentation took place in Las Vegas and virtually.
Epstein and colleagues conducted a review of current literature and evidence-based practice strategies in neuroimmunology. PW spoke with Epstein to learn more about her presentation, which focused on rational selection of disease modifying therapy (DMT) based on specific criteria including multiple sclerosis disease phenotype, risk for disability, contraindications, and patient lifestyle considerations. The discussion included recent data on DMT timelines, drugs in clinical trials, and research on the horizon, according to Epstein.
PW: What was the impetus for your study? What needs existed?
Kristi Epstein: The presentation was focused on the need for clinicians to understand treatment philosophies including escalating therapy versus induction therapy in selecting DMT. We discussed the use of advanced diagnostic tools, new biomarkers for determining prognostic outcomes, and understanding risk versus benefits of medication selection for specific conditions including radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, primary progressive MS, and discontinuation of therapy.
PW: What were your key findings?
Kristi Epstein: Treatment strategies have changed in recent years as advances in research have brought us more targeted, higher efficacious medications that can drastically reduce the risk for accruing disability in newly diagnosed patients with MS. Today’s research is focused on more targeted, brain penetrant small molecule therapies that can cross the blood-brain barrier. In addition, groundbreaking research by Benjamin Segal, MD, and Andrew Sas, MD, PhD, at Ohio State University has identified a neutrophil subset that can be polarized to function much like a stem cell and repair damaged nerves in the central nervous system (CNS) during a mouse-model optic nerve injury trial that has now expanded to human cells in vitro. Our findings may represent the “holy grail” of emerging science for therapies to restore patient function in CNS diseases.
PW: What would you like to see future research address?
Kristi Epstein: We hope to see combination therapies such as the use of high efficacy DMT at disease onset to reduce accrual of disability, the use of treatments to repair damage to the CNS during active relapse, and treatments that can enhance the remyelination process post-relapse in the comprehensive management of MS. Patients with MS will benefit from the use of advanced diagnostic tools such as optical coherence tomography and specific MRI protocols, biomarkers, and novel targeted DMT choices that will reduce the risk for disability, disease progression, and ultimately provide better patient outcomes.
