Putting Pharmacists at the Center of Multidisciplinary Multiple Sclerosis Care

Multiple Sclerosis (MS) Awareness Month highlights the experiences of individuals living with MS and the health care professionals working to improve their care and quality of life. As treatment options expand and care models become increasingly multidisciplinary, pharmacists are playing a growing role in supporting medication access, optimizing disease-modifying therapy, and helping patients navigate long-term disease management.

In this Q&A, Pharmacy Times interviewed Madison Gibson, PharmD, CPh, BCPS, a clinical ambulatory pharmacy specialist at Baptist Health South Florida, who discussed the complexities of MS diagnosis and treatment, the importance of interdisciplinary collaboration, and how pharmacists can better support patients throughout the course of their disease.

Pharmacy Times: Can you introduce yourself and describe your role at Baptist Health South Florida?

Madison Gibson, PharmD, CPh, BCPS: My name is Madison Gibson. Currently, my role is clinical ambulatory pharmacy specialist at Baptist Health Specialty Pharmacy. I work in a hybrid model, providing clinic-based services at Marcus Neuroscience Institute, part of Baptist Health South Florida, while also managing specialty pharmacy patients. I collaborate directly with our neurology interdisciplinary teams to provide specialized care to patients to ensure [they have] access to medications, disease state understanding, successful treatment of their conditions, and achieve the best possible clinical outcomes.

Pharmacy Times: From diagnosis through long-term management, what are the biggest challenges that you see in MS management?

Gibson: Some of the most significant challenges in managing MS involve establishing an accurate diagnosis and selecting the most appropriate treatment strategy. Diagnosis requires application of the McDonald Criteria specifically showing dissemination in time and space. This can be challenging due to the need to differentiate from other mimicking conditions and trying to identify when patients with clinically isolated syndrome will transition to clinical MS.

Treatment selection can be a challenge due to the wide variety of disease modifying therapies (DMT) available that vary in efficacy and drug safety profile. Providers differ in their approach to treatment, either starting with lower efficacy DMT then escalating after a relapse, or directly starting [a] high efficacy DMT. The decision is patient-specific to balance the benefit of preventing relapses, slowing disease progression, and risk for adverse events or other life circumstances such as family planning.

In addition, detecting breakthrough activity early to modify treatment while avoiding unnecessary escalation requires careful consideration. Specifically, primary progressive MS (PMSS) is an area with limited treatment options. Currently, ocrelizumab (Ocrevus; Genentech) is the only FDA-approved medication for PPMS.

Pharmacy Times: How do you collaborate with neurologists, nurses, infusion centers, specialty pharmacies, and other health care professionals to manage MS therapy?

Gibson: In my role, I serve as a medication liaison, partnering with our interdisciplinary team to bridge communication gaps across pharmacy service lines and streamline safe cost-effective access to efficacious medications.

Pharmacy Times: Are there gaps in MS care where you believe pharmacists could have an even bigger impact?

Gibson: MS care involves comprehensive symptom management requiring multidisciplinary collaboration. This can include medication management involving bladder and bowel dysfunction, pain, spasticity, fatigue, cognitive impairment, mood disorders and more. Pharmacists have an important role in education, reducing polypharmacy and adherence support. Patients often become fatigued with routine labs, imaging, and access issues, leading to loss to follow-up. Pharmacists have a vital role in navigating these areas with patients to help decrease confusion and burden.

Pharmacy Times: How does Baptist Health South Florida stand out compared to other health systems or institutions? What might you be doing differently in MS care, management, etc?

Gibson: Baptist Health South Florida encompasses Marcus Neuroscience Institute and Miami Neuroscience Institute, which provide care options to all South Florida, from Monroe to Palm Beach County. Our team at Marcus Neuroscience Institute is designated as a National MS Society MS Partner in Care. Partners in Care are health care providers who have demonstrated knowledge and expertise in treating people with MS. Our site is applying to become a center for comprehensive care to address the needs of those living with MS through coordinated multidisciplinary care.

Pharmacy Times: Are there any promising upcoming trials or treatments that you wanted to highlight?

Gibson: Yes, it’s a very exciting time for MS, and we’re seeing new target pathways being investigated.

Bruton tyrosine kinase inhibitors continue to be a mechanism of interest due to the potential impact on neurodegeneration beyond inflammation. Fenebrutinib (Genentech) has an ongoing phase 3 study, FENtrepid (NCT04544449). Frexalimab (Sanofi), an anti-CD40 monoclonal antibody, is a novel target that significantly reduced new gadolinum-enhancing lesions and showed a favorable safety profile in its phase 2 study (NCT04879628). The new molecule is undergoing phase 3 trials including FREXALT (NCT06141473) and FREVIVA (NCT06141486).

Cell therapies continue to be a growing area of interest including autologous hematopoietic stem cell transplantation and CD19-directed CAR-T cell therapy.

Pharmacy Times: How can pharmacists use MS Awareness Month as an opportunity to better educate and support patients—especially those newly diagnosed?

Gibson: Pharmacists can use this month to highlight their role within the care team and in supporting patients by becoming involved in community events. One example is the National MS Society hosts MS Walks around the United States to connect those with MS, including newly-diagnosed patients with the MS communities in local areas.

Pharmacy Times: Anything else you would like to highlight that you did not get the opportunity to discuss?

Gibson: I’m excited to share that at Marcus Neuroscience Institute, we are working on a collaborative practice agreement for MS and hopefully continuing to improve the continuum of care with this additional layer of collaboration.