Chris Hollen is Multiple Sclerosis Fellow and Rebecca Spain is a Neurologist and the Associate Director of Clinical Affairs for the MSCoE-West, both at the VA Portland Health Care System in Oregon. Mateo Paz Soldán is a Neurologist and the Clinical Director of the MSCoE-West Regional Program at the VA Salt Lake City Health Care System in Utah. John Rinker is a Neurologist and the Clinic Director of the MS Clinic at the Birmingham VA Medical Center in Alabama. Correspondence: Chris Hollen (hollen@ohsu.edu)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner,Frontline Medical Communications Inc., the US Government, or any of its agencies.
The development of numerous treatments for RRMS has established an entirely new landscape and disease course for those with MS. While this benefit has not entirely extended to those with progressive MS, those with active disease with superimposed relapses may receive limited benefit from these medications. New insights into the pathophysiology of progressive MS may lead us to new treatments through multiple alternative pathophysiologic pathways. Some early studies using this strategy show promise in slowing the progressive phase. Medication development for progressive MS faces multiple challenges due to lack of a single animal model demonstrating both pathology and clinical effects, absence of phase 1 surrogate biomarkers, and later phase trial endpoints that require large sample sizes and extended study durations. Nevertheless, the increase in number of trials and diversity of therapeutic approaches for progressive MS provides hope for effective therapy. Currently, the heterogeneity of the population with progressive MS requires an individualized treatment approach, and in some of these patients, stopping therapy may be a reasonable consideration. Symptomatic management remains critical for all patients with progressive MS as well as non-pharmacologic approaches that maximize quality of life.
