Multiple Sclerosis in Practice: Progress, Challenges, and the Future of the Disease

On the occasion of World Multiple Sclerosis Day on May 30, 2Logical interviewed neurologists from Italy, Portugal, and Spain, with the aim of providing an updated and multidisciplinary overview of the clinical, therapeutic, and organizational evolution in the management of a disease that affects millions of people worldwide.

From early diagnosis to artificial intelligence, addressing the challenge of progressive forms, this article provides an integrated view of Multiple Sclerosis (MS), enriched by the contributions of experts such as Dr. Orofino, a medical director of Neurology at the University Polyclinic of Cagliari. 

More Tools, Greater Complexity

All specialists agree: in the last five years, the management of MS has made significant progress. Therapeutic options have increased, and the personalization of approaches has strengthened.

“Management is now heavily oriented towards immunomodulation, much more than it was in the past,” emphasizes Dr. Orofino, who also highlights the growing use of high-efficacy therapies (HET) in the early stages of the disease.

From Portugal, there is an observed acceleration in the initiation of treatments after diagnosis, while Spain shows a commitment towards increasingly patient-centered medicine. At the European level, there is growing attention to progression, brain atrophy, and therapeutic response as new frontiers in clinical monitoring.

Progressive Forms and the Need for Biomarkers

Despite the successes, neurologists emphasize an urgent need: effective therapies for the progressive forms of MS, particularly Primary Progressive MS (PPMS). Current therapeutic approaches still show significant limitations in slowing the progression of disability.

“We still lack integrated treatments to combat the progression of disability,” a concern that Dr. Orofino shares, also highlighting the lack of a widespread support network, not only in medical terms but also psychological, care, and rehabilitation."

New Patient Profiles and Unmet Needs

The clinical profile of patients at diagnosis is changing. Neurologists report greater variability in terms of age, symptoms, and clinical form. Some Italian specialists have observed increased immune reactivity, while in Portugal, there is a reported increase in prevalence and greater aggressiveness from the onset.

Among the unmet needs are:

• Treatments for PPMS and SPMS

• Progression control independent of relapses (PIRA)

• Better management of invisible symptoms (fatigue, pain, cognitive decline)

• Access to multidisciplinary teams and rehabilitation programs

• Personalization of therapies, supported by biomarkers

Quality of Life and Psychosocial Impact

When asked which aspects of MS are undervalued in research or daily clinical practice, neurologists indicated several areas.

The etiopathogenesis of the disease remains a central concern for some, as do environmental factors. Others highlighted “quality of life and patient independence from caregivers,” “cognitive and psychiatric impact,” and “fatigue and changes in the emotional sphere.” The ability to predict relapses was also mentioned.

The Ideal Therapy and Vision for the Future

In the search for the ideal therapy, neurologists hope for a treatment with "high efficacy, high safety, and practicality (oral or low frequency)." They expect a therapy that also has "high adherence and tolerability," and is capable of "repairing and neuroprotecting." The ability to "prevent progression" is a shared desire.

Dr. Orofino believes the ideal therapy should be: effective, easy to use, and well-tolerated; preferably taken at home.

The vision for the next 10 years is one of hope but also realism. There is an expectation for "new therapies and new knowledge on etiology," "more patients with MS but with less disability," and "better control of the disease and its progression."

The chronicization of the disease with a good quality of life represents a goal, as does the development of “more effective therapies for progressive forms and reparative therapies.”

For many Italian doctors, personalized medicine will be the key to the future.

The Role of Artificial Intelligence

In the context of MS, Artificial Intelligence is seen as a promising tool for the future management of the disease.

For Dr. Orofino, artificial intelligence will assist “in the choice of treatments and in predicting long-term effects,” improving the accuracy and timeliness of clinical decisions.

Research Priorities

If they could guide new lines of research, specialists would focus on:

• Etiology and environmental factors

• Therapies for progressive forms and early biomarkers

• Neuroprotection and remyelination

• Pathophysiology of MS

Dr. Orofino would direct his research towards techniques for delivering drugs to specific sites in the nervous system.

A Message of Hope and Collaboration

The journey of patients with MS is complex and individual, but progress in understanding and treating the disease is remarkable.

The perspectives shared by neurologists demonstrate a continuous commitment to improving the quality of life for patients and fuel hope for a future in which MS will be managed more effectively and personalized.

Collaboration among researchers, clinicians, the pharmaceutical industry, and, above all, patients and their associations will continue to be the driving force for a future where Multiple Sclerosis can be managed more effectively and personalized. 

Acknowledgments

2Logical sincerely wishes to thank the neurologists who generously shared their knowledge and strategic insights.

A special thanks to Dr. Orofino for his contribution.

Also participating were:

• Dr. Roberto Bergamaschi (Italy)

• Dr. Franca Bilora (Italy)

• Dr. Iodice (Italy)

• Dr. Menichetti (Italy)

• Dr. Paolo Bellantonio (Italy)

In addition to the names listed above, other doctors experienced in the management of Multiple Sclerosis participated, who, while preferring not to be identified, provided valuable contributions to the content of this article. Our heartfelt thanks go to all of them.