Multiple Sclerosis – Unmet Need – Detailed, Expanded Analysis: Progression Independent of Relapse Activity (US/EU)

Marketed DMTs for multiple sclerosis deliver a high level of efficacy in preventing relapses and relapse-associated worsening of disability (RAW). However, MS patients still experience disability worsening that is temporally independent of relapses, referred to as progression independent of relapse activity (PIRA). PIRA may be driven in part by innate immune cells in the central nervous system (CNS). A wave of oral, CNS-penetrant Bruton’s tyrosine kinase inhibitors (BTKi) is in Phase 3, which hold the potential to deliver greater efficacy than current drugs in preventing PIRA. This report will examine the influence of PIRA and other outcomes on neurologists’ prescribing decisions and their level of satisfaction with current high-efficacy DMTs. It will also gauge the opportunity for emerging therapies to differentiate through an impact on PIRA and biomarker endpoints.


  • How important is a therapy’s impact on PIRA, RAW, or biomarker outcomes in neurologists’ selection of an MS DMT?
  • How do neurologists rate anti-CD20 MAbs, S1P modulators, and other MS DMTs on these attributes?
  • What is the relative level of need for improved treatment options to preventing PIRA?
  • Based on conjoint analysis and TPP simulation, what trade-offs among efficacy, safety, and price are neurologists willing to make for a hypothetical new drug for MS offering a larger impact on PIRA?


Unmet Need supports clinical development decisions by identifying key attributes and assessing areas of unmet need for a specific disease or subpopulation. Based on surveys with U.S. and European physicians, this report provides insight into key treatment drivers and goals, the performance of current therapies, and the remaining commercial opportunities. One market scenario is profiled in detail by Clarivate experts, and additional customized market scenarios can be evaluated with the corresponding TPP Simulator.

Markets covered: United States, United Kingdom, France, Germany

Primary research: Survey of 61 U.S. and 34 European neurologists fielded in December 2023

Key companies: TG Therapeutics, Novartis, Merck KGaA / EMD Serono, Roche / Genentech, Biogen, Sanofi

Key drugs: Briumvi, Fingolimod, Kesimpta, Mavenclad, Mayzent, Ocrevus, Tysabri, tolebrutinib, fenebrutinib, remibrutinib

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