AAN 2026: AI-powered MS blood test sees growing use in real-world care

Real-world use of Octave Bioscience’s artificial intelligence (AI)-powered blood test for classifying multiple sclerosis (MS) activity has increased substantially in the few years since its commercial U.S. launch.

In clinical practice, the multiple sclerosis disease activity (MSDA) test has mainly been used for routine monitoring, with additional uses including baseline assessment, risk stratification at diagnosis, and evaluating treatment response. Test data collected across the country also provide insight into how patients may be responding to disease-modifying therapies (DMTs).

The data were presented by Darin Okuda, MD, of the University of Texas (UT) Southwestern Medical Center, at the American Academy of Neurology annual meeting, being held April 18-22 in Chicago and online.

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“I think the MSDA panel, along with other [protein] panels, may really allow us to move away from full dependence on … neuroimaging, and more towards a more sensitive, biologically-grounded understanding of disease dynamics,” Okuda said in his talk titled, “Real-world Utilization of the Octave MSDA Test in Clinical Practice Across the US.”

MS is a neurodegenerative disease caused by the immune system’s mistaken attack on an otherwise healthy nervous system. Its symptoms and disease course can vary widely.

Doctors usually rely on routine MRI scans and clinical assessments to determine how the disease is progressing and responding to treatment. However, MRI scans are typically performed just once or twice a year, and symptoms don’t always accurately reflect true disease activity.

The MSDA test is designed to help doctors make more informed care decisions at any disease stage. It measures blood levels of 18 protein biomarkers linked to MS-related inflammation and uses an AI algorithm to generate a disease activity score, categorized as low, moderate, or high.

First launched in the U.S. in 2022, it has been available in all 50 states since May of last year but is not available in other countries. The test has been clinically validated, showing that people with higher MSDA scores are at a greater risk of having lesions with active inflammation, according to Okuda.

In the presentation, Okuda discussed real-world data from the MSDA test. Use of the test has increased more than tenfold from 2022 to 2025, “suggesting strong clinical adoption,” Okuda said.

Use of MS blood test expands across U.S. providers and patients

As of the end of January, more than 25,000 MSDA tests have been administered to nearly 18,000 people with MS. Correspondingly, the number of providers and institutions using the test has increased. More than 400 providers across 237 institutions and 41 states have ordered it.

Among those tested, the average age was 52.4, and the average disease duration was about 14 years. Most were female and white.

As of their latest test, 44.5% of patients were on high-efficacy DMTs, just over 20% were on moderate- or low-efficacy treatments, and 34.7% were not on any DMT.

Data from patients who had more than one test showed that, on average, disease activity scores decreased over time among those initially categorized as moderate- or high-risk. Scores were generally stable in those with low disease activity.

These reductions exceeded the test’s minimum detectable change threshold, indicating clinically meaningful changes among people initially in the high-risk group. The data generally suggest that treatment approaches in those with high disease activity have been effective, Okuda explained.

Looking at DMT classes, anti-CD20 therapies — which include Ocrevus (ocrelizumab), Kesimpta (ofatumumab), and Briumvi (ublituximab-xiiy) — were associated with the lowest MSDA scores. Untreated patients and those on glatiramer acetate (e.g. Copaxone) tended to have the highest scores.

“But I think what’s really important here is that there is still a range of scores by individual DMT and also by DMT class,” Okuda said. “This may be reflective of differences in the individual disease biology and/or people aren’t responding to treatment as we expect them to.”

Clinicians use MS blood test to guide care decisions in practice

In clinical practice at UT Southwestern, the MSDA test serves five main functions: to stratify risk and inform care decisions at diagnosis, to confirm a disease relapse, for routine monitoring of ongoing disease activity, for tracking changes during high-risk periods, and as an alternative to more expensive and less accessible MRI scans.

Okuda says that at this institution, risk stratification at diagnosis is a core use. He noted that many patients are resistant to taking DMTs, and the MSDA score “really allows us to counsel patients better, to encourage them to perhaps consider treatment.”

The team is also using the test as part of a project that’s tracking disease activity changes through pregnancy and the postpartum period.

For MSDA tests ordered across the U.S., the majority have been ordered for routine monitoring (63.9%) or initial assessments (29.3%).

Octave has been working to make the MSDA test as accessible as possible, including a financial assistance program. Okuda said that about 90% of patients pay nothing, while the rest pay less than $100.

Overall, the MSDA test is a “versatile, blood-based tool for longitudinal MS management, relapse assessment, and treatment optimization,” Okuda said, concluding that the test represents “a shift toward proactive, biomarker-driven MS care.”