How MS Treatment Strategies Are Evolving: Rebecca Spain, MD

In recent years, the management of multiple sclerosis (MS) has undergone significant transformation, moving away from a gradual escalation of therapies toward a more proactive, early intervention approach. At the Institute for Value-Based Medicine event hosted by The American Journal of Managed Care^® in Portland, Oregon, on October 21, 2025, Rebecca Spain, MD, MSPH, FAAN, associate professor of neurology at Oregon Health & Science University, and codirector of MS Center of Excellence–West at the Portland Veterans Affairs Medical Center, spoke about this in her session, “Management of Patients with Multiple Sclerosis.” In this interview, she discusses how early use of highly effective disease-modifying therapies has improved long-term outcomes, delaying disability progression and the shift to secondary progressive MS.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How has the management of patients with multiple sclerosis evolved in recent years?

I would say one of the most notable shifts has been the change from an escalation approach to treating MS, in terms of disease-modifying therapies, to more of an induction approach, where right from the earliest point we can feel confident it's an MS diagnosis we're treating with as effective but also as safe a treatment as we possibly can. Long-term studies have shown that treating early and with highly effective therapy has led to reductions in long-term disability and shifted the transition from relapsing MS—which most people have at disease onset—shifting that or delaying that transition from relapsing MS to secondary progressive MS, where we don't yet have effective treatments. Anything that lowers that disability and delays that shift to progressive MS is a real win. Treating with our more effective therapies, or our highly effective therapies, as early as possible in the disease process has been a real win for the field.

I would say a second shift in the field has been to look at what is sometimes called “silent progression” in between relapses. That silent progression can be in areas that are harder to see and maybe doesn't necessarily show up as a physical manifestation that would show that somebody's disability is worse. We have a disability scale that's very heavily weighted towards walking and the ability to walk, but there [are] other really important aspects to MS that can worsen. Those include things like fatigue or cognitive dysfunction, bladder function, and sexual dysfunction. These things are difficult to quantitate, and they can worsen in between relapses. They're important to know about because they might require a change in MS therapy, they might require more symptomatic management, and they're really impactful to people with MS, and so they need to be focused on so that we can help improve their quality of life.