International Advisory Committee on Clinical Trials in Multiple Sclerosis Suggests New Framework for Defining Progression of Multiple Sclerosis

The International Advisory Committee on Clinical Trials in Multiple Sclerosis proposed a new mechanism-driven framework for defining progression in multiple sclerosis (MS). The recommendations presented at the 2023 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) identify major revisions to the current Lublin-Reingold clinical course descriptors based on evidence which supports the clinical course of MS as a spectrum. The mechanism-driven paradigm considers the role of life span changes and the unique contributions of pathological and reparative/compensatory processes that impact individuals throughout the clinical course of MS.

A working group of experts generated consensus around the mechanism-driven framework by reviewing current knowledge and classification of MS, defining the onset of progression in MS, and evaluating progression in MS in clinical trials and clinical practice. Their findings suggest a progressive course of MS due to a shift from acute injury to widespread inflammation and neurodegeneration alongside the loss of compensatory mechanisms.

Although the consensus perspective of the committee involves replacement of clinical classification of MS, members acknowledge that adoption and implementation of the mechanism-driven framework must consider the emergence of biomarker-based and biologically informed treatment decisions. The committee was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis and the National Multiple Sclerosis Society and included experts from 11 global MS institutions.