Understanding the Multiple Sclerosis Disease Continuum and the Consequences of Untreated Progression

Welcome back to another Pharmacy Times series. In this episode titled, Understanding the Multiple Sclerosis Disease Continuum and the Consequences of Untreated Progression, Kiranpal Sangha, PharmD highlights the continuum of multiple sclerosis and the effects of anti-inflammatory therapies on disease progression.

Rather than existing as distinct clinical entities, MS subtypes are now understood to represent points along a continuous disease spectrum. Patients may initially present with clinically isolated syndrome or relapsing-remitting MS, marked by episodic inflammatory activity and periods of recovery. Over time, many individuals transition to secondary progressive MS, where gradual and irreversible neurologic decline becomes the dominant feature. Some patients experience primary progressive MS from onset, with steady worsening of disability and fewer overt inflammatory relapses. Understanding this disease continuum is essential for early recognition, appropriate monitoring, and timely therapeutic intervention.

When patients are not treated with anti-inflammatory disease-modifying therapies, the underlying immune activity driving MS remains unchecked. Acute relapses may occur more frequently and recovery may be incomplete, leading to cumulative neurologic damage. Even in the absence of obvious clinical relapses, subclinical inflammatory activity and ongoing neuroaxonal loss can silently advance disease progression. Over time, this results in increasing physical disability, cognitive impairment, fatigue, and reduced quality of life. Delayed treatment initiation has been associated with higher lesion burden on imaging, accelerated brain atrophy, and earlier transition to progressive disease phases.

Led by the moderator, a neurology expertexamines the following critical questions:

Can you please explain the disease continuum of multiple sclerosis?

How do patients progress when they aren’t on anti-inflammatory therapy?

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

In the next episode, PIRA and the Pharmacist’s Role in Early Disability Recognition in Multiple Sclerosis, panelists will continue their discussion on multiple sclerosis and highlight understanding PIRA as a central driver of MS disability, as well as pharmacist best practices in early detection and disability identification.