November 12, 2025 | News | MS Research MS Treatments

MS medications in development – New Research

Part 2

In the last issue of MSology we looked at the latest information on MS medications presented at the European Committee for Treatment and Research in MS (ECTRIMS) meeting, the year’s largest congress on MS research. A highlight of the meeting was new data on the many MS medications currently in development.

Although two dozen medications are currently available to treat MS, the current crop of drugs all act primarily by targeting inflammation in the central nervous system (CNS). This approach reduces relapses and slows disability worsening. But it is not highly effective in controlling the many underlying disease mechanisms that contribute to the nerve damage that is the main cause of disability. So different treatment strategies are needed.

New information for four MS medications was presented at ECTRIMS. The first drug was tolebrutinib, which is a BTK inhibitor. BTK (for Bruton’s tyrosine kinase) is an enzyme that activates immune cells in the brain so inhibiting it may control the smouldering inflammation in the CNS that causes nerve damage. Two studies in relapsing MS (called Gemini 1 and 2) were somewhat disappointing because tolebrutinib appeared to be no better than Aubagio (Oh and colleagues. N Engl J Med 2025;392:1893-1904). A trial in secondary-progressive MS (called HERCULES) was more encouraging (Fox and colleagues. N Engl J Med 2025;392:1883-1892). Treatment reduced disability worsening by 31% compared to a placebo in people with no relapses, which suggested that the disability that was occurring was due to nerve damage rather than inflammation. The latest analysis found that treatment was effective in various subgroups, including people with more severe disability and those living with MS for over 10 years (Fox and colleagues. ECTRIMS 2025;P796).

Fenebrutinib is another BTK inhibitor that appears to act somewhat differently from tolebrutinib. A short-term study (called FENopta) found that the drug reduced relapses and inflammatory lesions seen on MRI (Bar-Or and colleagues. Lancet Neurol 2025;24:656-666). This efficacy appears to be sustained for up to four years (Oh and colleagues. ECTRIMS 2025;O112).

Fenebrutinib is reportedly better than Aubagio in slowing disability progression, according to the results of the FENhance study that were recently announced (www.roche.com/media/releases/med-cor-2025-11-10). A second study in primary-progressive MS (called FENtrepid 1 and 2) also found that fenebrutinib was superior to Ocrevus. These data have not yet been published so we’ll have to wait until next year to see the final numbers.

Frexalimab is a new treatment in development that targets the immune response more broadly without destroying immune cells (unlike many of the current MS drugs). This novel approach has been shown to be effective in suppressing new MRI lesions in the short term (Vermersch and colleagues. N Engl J Med 2024;390:589-600). The latest results show that efficacy is maintained for up to two years (Giovannoni et al. ECTRIMS 2025;O111). The most common side effect was headache.

The fourth new treatment is vidofludimus calcium, which inhibits the same enzyme that is blocked by Aubagio but also lowers the activity of damaging immune cells in the CNS. This dual mechanism of action appeared to reduce disability worsening in people with primary-progressive and secondary-progressive MS – an important unmet need with current MS medications.

MS research in recent years has shown that inflammation and demyelination trigger downstream effects that are numerous and complex. But these effects also reveal new targets for medications that may translate into more substantial and long-lasting benefits for people with MS in the future.

In Part 3 of this series we will look at the latest information on how nutrition can affect MS.

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