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ECTRIMS 2023 | Investigating the pathophysiological mechanisms of MS progression

Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, discusses the intricate pathophysiological mechanisms characterizing the evolution of multiple sclerosis (MS). Traditional understanding cites a relapsing-remitting phase followed by a secondary progressive phase in approximately 90% of patients. However, recent studies from 2019 highlight that most disability progression during the relapsing phase is unrelated to relapses, coining the term “”silent progression””. Prof. Comi cautions against potential misinterpretations, emphasizing the importance of longitudinal MRI studies and ensuring that disability increases are both sustained and confirmed over time. The data suggests that early aggressive treatments can delay the onset of the progressive phase. Conclusively, Prof. Comi emphasizes the significance of accurate diagnoses and proposes a future shift towards classifying MS progression based on underlying molecular mechanisms. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2023 in Milan, Italy.

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G. Comi has received consulting and speaking fees from Novartis, Sanofi, Bristol-Myers Squibb, Janssen, Aspen Healthcare.