Novel Neurotherapeutic Class May Prove Beneficial for Both Relapsing, Progressive MS

Among an emerging slate of neurotherapeutics for patients with multiple sclerosis (MS), Bruton’s tyrosine kinase (BTK) inhibitors are a “provocative” new therapeutic class, reports a review article published in Neurodegenerative Disease Management. The novel drug class targets both the adaptive and innate immune systems in the periphery and central nervous system (CNS) through the modulation of B lymphocytes and microglia.

“As is currently being studied in late-phase clinical trials, targeting B lymphocytes and CNS-resident microglia may lead to clinically meaningful effectiveness for patients with both relapsing and progressive MS,” wrote corresponding author Carrie M. Hersh, DO, of the Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas, Nevada, and Moein Amin, MD, of the Cleveland Clinic Department of Neurology in Cleveland, Ohio.

The review provides a summary of the evolving landscape of MS treatment options, including disease-modifying therapies (DMTs), investigative remyelinating strategies, impending neurotherapeutics, and stem cell therapies.

Non-active progressive MS has garnered special focus among researchers as of late due to the limited therapeutic options available, the article notes.

“As such, concerted efforts are focused on targeting neurodegenerative pathology with high-throughput screening for drug discovery for patients with progressive MS,” the authors wrote.

The review also addresses the need for further study into meaningful and feasible treatment targets for patients with MS. “No evidence of disease activity” is commonly used for relapsing forms of MS, but it can be difficult to achieve and, with inflammation reduction being the primary focus of DMTs, can result in excessive rates of “treatment failure” and DMT switching. Some have suggested “minimal evidence of disease activity” as a more appropriate treatment target.

“The field of MS is clearly rapidly expanding across a plethora of opportunities, which ultimately will lead to better individualized and accessible care for patients,” the authors wrote.

Reference

Amin M, Hersh CM. Updates and advances in multiple sclerosis neurotherapeutics. Neurodegener Dis Manag. 2023;13(1):47-70. doi:10.2217/nmt-2021-0058