Battle of the Biomarkers: Assessing Key Factors in Prognosis, Monitoring, and Therapeutic Decision-Making for Disease Worsening in Multiple Sclerosis


Over the past several years, the image of MS has been changing from distinct categories of disease to a complicated spectrum of interwoven pathologies. As this knowledge evolves, so do approaches to prognosticating, monitoring, and responding to disease. With many markers of progression still under investigation and therefore not included in modern guidelines, MS clinicians are left on their own to decide which factors should hold the most weight in influencing clinical decisions. In this “debate-themed” symposium originally held in conjunction with the 2023 ACTRIMS Forum, Drs Shin, Alvarez, and Oh advocate for their preferred disease indicators and why they are the future of successful MS disease management. In the absence of professional guidelines, these expert perspectives may deepen the understanding of exactly how and why these factors should be considered, improving clinicians’ ability to navigate and optimize available tools and strategies for their own patients.

Target Audience

This activity is intended for neurodegenerative disease specialists, general neurologists, nurse practitioners, physician assistants, and other healthcare professionals involved in the diagnosis and long-term management of patients with MS.

Learning Objectives

Upon completion of the educational activity, participants should be able to:

  • Assess the relative roles of existing and emerging predictors/indicators of disease progression to guide the prioritization of these factors in proactive assessment of patient changes
  • Appraise the utility of clinical and radiologic assessments of disease progression to select the most sensitive and clinically appropriate monitoring tools that will not disrupt current workflow
  • Evaluate published research and expert experience guiding initial and subsequent disease modifying therapy choices in patients with different MS presentations to optimize therapeutic decision-making and maximize patient outcomes
Course summary
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   Robert Shin, MD, FANA, FAAN (Moderator and Chair)
   Director, Georgetown Multiple Sclerosis and Neuroimmunology Center
   Professor, Department of Neurology
   MedStar Georgetown University Hospital
   Washington, DC



   Jiwon Oh, MD, PhD, FRCPC
   Medical Director, Barlo MS Program
   St. Michael’s Hospital
   Scientist, Keenan Research Centre
   Li Ka Shing Knowledge Institute
   Associate Professor of Medicine
   University of Toronto
   Toronto, Ontario, Canada
   Enrique Alvarez, MD, PhD
   Associate Professor, Neurology
   Vice-Chair of Clinical Research, Department of Neurology
   University of Colorado Hospital
   Aurora, CO 



Credit for this program has expired. The accreditation information below is based on the activity release date.

This activity is jointly provided by Purdue University College of Pharmacy Office of Continuing Education and Professional Development and Efficient LLC.

Accreditation Statement

This enduring activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Purdue University College of Pharmacy Office of Continuing Education and Professional Development and Efficient LLC. Purdue University is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Purdue designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A Certificate of Participation will be given upon completion of the enduring activity enabling participants to register their credit with the appropriate licensing boards or associations.

Conflicts of Interest Disclosure Policy

To ensure compliance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education, Purdue University requires that all individuals in a position to control the content of an educational activity disclose all financial relationships with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All relevant conflicts of interest identified are thoroughly assessed by Purdue University to ensure fair balance, scientific rigor, and accepted patient care recommendations of the educational activity.

All relevant conflicts of interest have been mitigated prior to the start of the activity.

None of the planners, reviewers, Efficient, LLC staff, and Purdue University College of Pharmacy staff have relevant financial relationship(s) with ineligible companies to disclose unless listed below.

Planners' and Managers' Disclosure

All additional planning committee members, staff and reviewers of Efficient LLC and Purdue University College of Pharmacy have no relationships to disclose.

Faculty Disclosure

Dr. Shin reported the following financial relationships:

  • Consulting Fees: Alexion, Bristol Myers Squibb (BMS), EMD Serono, Genentech, Horizon, Icometrix, Novartis
  • Speakers' Bureau: Alexion, BMS, EMD Serono, Genentech, Horizon, Novartis, Sanofi Genzyme (Sanofi) 

Dr. Oh reported the following financial relationships:

  • Consulting Fees: Biogen-Idec (Biogen), BMS, EMD Serono, Lilly, Novartis, Roche, Sanofi
  • Grants/Research Support: Biogen, EMD Serono, Roche
  • Advisory Board: Biogen, Novartis, Roche, Sanofi
  • Speakers Bureau: Biogen, BMS, EMD Serono, Novartis, Roche, Sanofi

Dr. Alvarez reported the following financial relationships:

  • Advisory Board: Alexion, Biogen, Celgene/BMS, EMD Serono/Merck, Genentech/Roche, Novartis, Sanofi, TG Therapeutics
  • Grants/Research Support: Biogen, Genentech/Roche, Novartis, National Institutes of Health, National Multiple Sclerosis Society, Patient-Centered Outcomes Research Initiative, Rocky Mountain MS Center, TG Therapeutics

Disclosure of Unlabeled Use/Disclaimer

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation. 


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