Neurologists in the U.S. are largely satisfied with current treatment options for relapsing-remitting multiple sclerosis (RRMS), but opportunities remain for therapies in development, according to a new report by Spherix Global Insights. In the report series, called RealTime Dynamix: Multiple Sclerosis (U.S.), an ongoing survey of healthcare providers on MS disease-modifying therapies (DMTs), neurologists outlined their expectations for new therapies. In particular, drugs with advantages in administration or efficacy over the highly effective CD20 inhibitors, those with better risk-benefit profiles, and treatments for progressive forms of multiple sclerosis (MS) are all expected to succeed in the market. Since 2017, the U.S. Food and Drug Administration (FDA) has approved eight DMTs to prevent relapses and slow disability progression in MS, which is caused by immune-mediated damage to the spinal cord and brain. Spherix’s data showed MS specialists and neurologists have adopted a “high efficacy first” treatment approach in recent years. This change, consistent with real-world data that shows higher efficacy DMTs lead to better outcomes, should guide the development of new therapies, the company noted in a press release. Minimize relapses, delay disability progression. Minimizing relapses and delaying disability progression motivated prescribing tendencies, according to a recent survey of 102 neurologists in the U.S. Patient support services, by contrast, are no longer considered when selecting first-line therapies. DMTs rated best by neurologists at minimizing relapses and disease progression were those that deplete antibody-producing B-cells by targeting the CD20 receptor. These include Kesimpta (ofatumumab), Ocrevus (ocrelizumab), and the recently approved Briumvi (ublituximab-xiiy). This is the only class of therapies projected by neurologists to be prescribed more often in the next six months, data showed. Neurologists recommended that any new DMT will have to be equally effective as these anti-CD20 therapies to be accepted and prescribed, but other factors, such as advantages in administering treatment, may drive preferences too. Having an excellent risk-benefit profile may also help new therapies find a place in the market. Anti-CD20 antibodies, which are infused intravenously (into the vein) or subcutaneously (under the skin), have outperformed high-efficacy oral treatments, as well as other RRMS therapy classes, Spherix’s tracking data showed. This indicated that “neurologists’ safety perceptions for anti-CD20s are proportionally positive to their efficacy expectations,” according to Spherix. However, brand loyalty assessments indicated Ocrevus and Kesimpta are not necessarily preferred among neurologists, demonstrating the potential for new therapies with a strong safety and efficacy balance. Unmet medical needs in treating MS. Neurologists considered effective management of primary progressive MS (PPMS) and secondary progressive MS (SPMS) as the greatest unmet medical need. Due to the lack of effectiveness, most available DMTs aren't considered a viable treatment option for progressive forms of MS. Thus, only 70% of PPMS patients and 60% of those with non-active SPMS have received a DMT. New PPMS or SPMS therapies are projected to have significant market success. Regarding experimental therapies in clinical testing, those that block the action of Bruton tyrosine kinase — called BTK inhibitors — such as tolebrutinib and evobrutinib are expected to gain acceptance, if approved, due to their new mechanism of action. Most neurologists surveyed rated both as “highly likely to be prescribed.” A subcutaneous formulation of Ocrevus, which has been shown to be comparable to the intravenous version and may be filled for approval early next year, will be watched to see if it's preferred due to its administration advantage, Spherix noted. “Breaking into the [RRMS] market will certainly not be easy, so deep market insights will be key along with outstanding clinical data,” the company said.