Well the answer is maybe, but we know historically the answer is “no” as we have seen things splintering off MS such as neuromyelitis Optica. It has been peeled away and it would be unsurprising that there is yet more of the onion to peel away.
However this is not what I mean, I have heard this term being used more recently and feel that there is some marketeering occuring so that the splitters will be made lumpers so that you treat all of MS with one agent not having to do studies in relapsing and progressive MS. At the moment I think there are at least two fundamentally different processes in relapsing and progressive MS that are both present in both from beginning to end. However, I think these are not separate entities and are interlinked. This is clearly evident to me in mouse.models.of.MS.
The BTK inhibitors are suggested to target both the B cells and the microglia and so will target both of the mechanisms that are important for relapsing MS (B cells) and progressive (microglia). I think microglia are involved in relapsing MS and B cells are involved in progressive MS but they are performing different processes.
So we have “MS is one disease” and now one drug works for all…probably a slogan for a future ECTRIMS…..but it isn’t straight forward for the BTKi and tolebrutinib is a good example. Evobrutinib was the first to fall, it failed to inhibit relapsing MS….I had a medical student write an essay on the BTK inhibitors and with no prior knowledge and no previous experience the student predicted evobrutinib would fail in the phase III trial….I kick myself that we did not publish this, before the phase III trial result….I think the dose wasn’t right and the data from the phase II trials showed it wasn’t good enough and was no better than beta interferon.
Tolebrutinib failed in relapsing MS and but it inhibits progressive MS. However did it make relapse worse as there were l
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Source: multiple-sclerosis-research.org