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WCN 2021 | Limitations of the current multiple sclerosis classification

Mar Tintoré, MD, PhD, Vall d’Hebron University Hospital, Barcelona, Spain, comments on the classification of multiple sclerosis (MS) and suggests improvements. Prior to 2013, MS was categorized into relapsing-remitting (RRMS) and secondary progressive (SPMS). This was reviewed in 2013 and divided progressive MS into a primary (PPMS) and a secondary subtype, further classified according to the presence or absence of activity. Dr Tintoré underlines the importance of incorporating the pre-symptomatic phase into the phenotype classification and also suggests measuring progression earlier than it is currently done. This interview took place during the XXV World Congress of Neurology.

Transcript (edited for clarity)

Well, I think currently we are still classifying this disease as a relapsing-remitting secondary progressive MS, primary progressive MS. And this is really what is much used in clinical practice. It is true that the classification that came out in 2013 already made an important change because primary and secondary progressive MS were like merged into a progressive category, which then is classified according to the presence or absence of activity, which means inflammation...

Well, I think currently we are still classifying this disease as a relapsing-remitting secondary progressive MS, primary progressive MS. And this is really what is much used in clinical practice. It is true that the classification that came out in 2013 already made an important change because primary and secondary progressive MS were like merged into a progressive category, which then is classified according to the presence or absence of activity, which means inflammation. And I think this is an important distinction that is already there. And that, to my understanding, is so much more upgrade than the previous one into relapsing-remitting and secondary progressive, but probably we need to go much further.

It is true that we are now having a lot of data, for example, showing that this disease probably starts many years before than when we have a CIS, okay? So probably this presymptomatic phase either if we call it radiologically isolated syndrome, or if we call it to the prodrome, but all this period probably should be also incorporated into the phenotypes because this is a very important period. And probably this is where we need to start acting. Okay. So for example, a first proposal would be that all this presymptomatic phase could be included into the phenotypes.

And probably also this classification that starts considering progression only when the patient is really having any EDSS of four. This is also probably far too late, and we have also data showing that we have patients that progress from onset. And the problem is that we do not measure in a proper way this progression. So probably there’s room for incorporating, for example, progression from early onset, rather than considering that progression starts at the EDSS of four.

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Disclosures

Dr Tintoré has received compensation for:
Consulting services and speaking honoraria from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Jansen, Merck-Serono, Novartis, Roche, Sanofi-Aventis, Viela Bio and Teva Pharmaceuticals.
Receipt grants and research supports from Carlos III Health Institute, Foundation Genzyme, Foundation Salud 2000. Biogen-Idec, Novartis.