Multiple disease modifying therapies (DMTs) are available for relapsing forms of MS, including active secondary progressive MS (SPMS). Only one DMT is approved for primary progressive MS (PPMS). There is a lack of effective treatments for neurodegeneration injury and progressive MS. Clinical trials remain the fundamental way to establish a treatment benefit.
To date, defining MS by clinical phenotype remains the accepted approach, and we should not abandon this. We need to focus on progressive MS, both active and not active, and document whether therapies can slow neurodegenerative injury. This discussion will make the case for pursuing such trials.