Biomarkers, Evolving Subtypes, and Redefining Disease Classification in Multiple Sclerosis

In Biomarkers, Evolving Subtypes, and Redefining Disease Classification in Multiple Sclerosis, Millad Sobhanian, PharmD, BCPS, and Kiranpal Sangha, PharmD, delve into focusing on the role of biomarkers in MS management and key updates in the classification of subtypes.

Advances in multiple sclerosis (MS) research have highlighted the growing importance of biomarkers in improving both diagnosis and long-term disease monitoring. Biomarkers derived from imaging, serum, and cerebrospinal fluid—such as MRI lesion activity, neurofilament light chain levels, and markers of neurodegeneration—are increasingly used to detect early disease, assess treatment response, and identify ongoing progression that may not be apparent through clinical relapses alone. As understanding of MS biology deepens, biomarkers are becoming essential tools for revealing subclinical disease activity and guiding more personalized therapeutic decisions.

At the same time, evolving insights into disease mechanisms have raised questions about the adequacy of traditional MS subtype classifications. Non-relapsing secondary progressive MS (nrSPMS) represents a stage where patients experience steady disability progression without clear relapse activity, underscoring the role of neurodegenerative processes independent of acute inflammation. This contrasts with relapsing-remitting MS, where inflammatory relapses dominate early disease, and primary progressive MS, which shows progression from onset. Recognition of nrSPMS and phenomena such as progression independent of relapse activity challenge the historical framework of discrete MS subtypes.

Together, emerging biomarker data and refined understanding of progression are reshaping how MS is defined, monitored, and treated. This shift raises important considerations about whether current subtype labels remain sufficient or if a more biologically driven classification system is needed to better reflect the continuous and evolving nature of MS.

Led by the moderator, the neurology pharmacists examine the following critical questions:

What is the role of biomarkers in both diagnosing and monitoring for disease progression?

What are the key differences between nrSPMS and other types of MS?

Do you feel the current MS subtypes are sufficient when the biological understanding of the disease is shifting?

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, Neuroinflammation and Disability Progression: Evolving Insights in Multiple Sclerosis, further explores multiple sclerosis, highlighting the role of neuroinflammation and clinical considerations for evaluating disease progression in MS.