MSToronto2026 was held from 21-23 October, bringing together researchers, clinicians, healthcare practitioners, industry partners and members of the MS community from all over the world. The meeting united us in a shared purpose to advance knowledge, improve care, and create better outcomes for people with MS and related disorders.
MSToronto2026 was the 10th joint meeting of the European (ECTRIMS) and Americas (ACTRIMS) Committees for Treatment and Research in MS. More than 7,000 people attended in person and online, with over 300 oral and 1,800 poster presentations showcasing the latest in research MS and related disorders and creating valuable opportunities for collaboration.
The ECTRIMS Patient Community Day brought the latest research updates from MSToronto26 directly to people living with MS, NMOSD, and MOGAD, their families and carers. Researchers and health professionals explained key findings in a clear, practical, and accessible way, including what they could mean for diagnosis, treatment and everyday life. Over 4,000 people registered for the event, and you can sign up to view a replay of the event here.
The Late-Breaking Abstracts session presented the newest results, including those from final stage clinical trials. Here are our selected updates from the meeting.
Unifying Multiple Sclerosis
The theme of this year’s meeting was Unifying Multiple Sclerosis. In part, this reflects our new understanding of MS biology – that relapsing and progressive MS are not separate diseases but share underlying processes. Attendees were also asked to consider how we can unify our understanding of MS, connect research more closely with clinical practice, and ensure that progress reaches the people and communities who need it most.
Emerging “biological” definitions of MS – relapsing and progressive
The international community is increasingly calling into question the strict definitions of MS into relapsing-remitting, secondary progressive and primary progressive categories. While we know that MS relapses can lead to progression of disability, analysis of large clinical trials has revealed that progression of disability can also occur independent of MS relapses, and that this can happen from very early in the disease course.
Professor Daniel Ontaneda explained that there are two separate processes at play – with acute immune attacks on the brain and spinal cord during relapses, but a slower-burning and more confined immune attack in progressive disease (Presentation S2.1*) This has huge implications across the field, and the international community has developed a roadmap for how to tackle this over time. Most importantly, this new biological understanding will open new avenues to treat MS more effectively.
An important first step is being able to detect both processes in an individual. Professor Ontaneda described how clinical measures, blood tests and MRI can be used to distinguish progressive and relapsing biology. Reports from the person about their own disease experience is also important in understanding which processes are at play. Many of these are not yet confirmed as definitive tests, but work is ongoing in this area.
Building on this, Professor Heinz Wiendl described how researchers are working on various mathematical models, using objective data from MRI, clinical tests and blood tests to classify different MS disease states. The aim is to help objectively predict how a person’s MS will track over time, and how they will respond to therapy. This would help reduce uncertainty and assist management of MS (S2.2).
MS Diagnosis
The diagnostic criteria for MS, called the McDonald criteria, were updated in 2024 to support earlier and more accurate diagnosis. The updated criteria added new measures including recognising damage to the optic nerve, new features seen on MRI scans, and a more sensitive test called the kappa free light chain test, which detects signs of immune activity in the fluid surrounding the brain and spinal cord (cerebrospinal fluid).
A study across six European centres showed that the new criteria enabled earlier diagnosis – around four months compared with 16 months –identified more people with MS (82% compared with 63%) than the 2017 criteria. Of the new measures, optic nerve testing increased MS diagnosis the most (O002). Another Austrian and Swiss study found the same trends (O003).
However, distinguishing MS-related damage to the optic nerve from damage caused by other conditions can be challenging. A late-breaking abstract presented a new diagnostic framework, developed by 46 international experts, to support accurate assessment of optic nerve damage in MS (O136).
Repair and remyelination
While current MS therapies help control the immune attack on the brain and spinal cord, none can yet repair damage to the myelin – the protective coating around the nerves.
Associate Professor Nick Cunniffe from the University of Cambridge summarised several completed clinical trials of potential remyelinating treatments, including clemastine, clemastine plus metformin, bexarotene, PIPE-307, opicinumab and GSK293512.
Some of these produced small improvements in measures of nerve function and myelin repair on MRI scans, but these were not large enough to provide a clinically significant improvement. This may partly reflect the short length of the clinical trials.
Encouragingly, the results show that remyelination is possible. In the bexarotene and clemastine trials, improved nerve function was linked with lower levels of a blood marker for nerve damage. Researchers are continuing to improve the design of remyelination clinical trials (S15.1).
GLP-1 receptor agonists in MS
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide (Ozempic, Wegovy, etc.), are approved to manage diabetes and obesity. They may also affect inflammation and nerve health, but their potential role in MS remains uncertain.
Researchers compared health data from 14,300 people with MS taking GLP1-RAs with data from 339,000 people with MS who were not taking GLP1-RAs. The people with MS taking GLP1-RAs had higher body mass index, higher rates of type 2 diabetes and higher rates of obesity.
GLP1-RA use was associated with lower rates of acute steroid-treated relapses (2.33% vs 5.0%) and optic neuritis (1.53% vs 4.02%), demyelinating events (3.58% vs 6.5%), walking abnormalities (7.56% vs 12.76%), fatigue (8.3% vs 14.2%), and depression (18.1% vs 25.2%). Similar results were found when the analysis was limited to people treated with ocrelizumab.
These results suggest that GLP-1 RAs may be associated with improved outcomes in MS, but appropriately designed clinical trials are required to answer this question (O056).
CAR T-cell therapy in progressive MS
CAR T-cell therapy is an experimental therapy that modifies immune cells called T cells so that they can recognise and attack specific cells in the body. In MS, CAR T-cells are being tested to target B cells involved in the disease. Unlike antibody treatments, CAR T-cells can enter the brain and spinal cord, where they could act directly on disease processes and potentially help “reset” the immune system.
CAR T-cells can be made from a patient’s own cells or donor cells (sometimes called “off-the-shelf”). Researchers are also exploring ways to create them inside the body by delivering genetic instructions, avoiding the need for separate cell manufacture. However, there have been some serious safety concerns with CAR-T therapy, with one company recently halting eight clinical trials.
Late-breaking results were also presented from TG-Azercel-101 (Azer-cel), the first phase 1 clinical trial of an off-the-shelf CAR T-cell therapy in progressive MS. The treatment targets B cells, aiming to reduce them in the blood, brain and spinal cord, potentially resetting the immune system.
The trial included 26 participants with progressive MS whose disability had recently worsened independently of relapses. Azer-cel markedly reduced B cells in the blood and cerebrospinal fluid in 25 participants.
Early safety results were encouraging, with no neurological toxicity, severe infections or serious immune complications or reactions in which the donor cells attacked the participant’s body. Most participants were clinically stable or showed improvements in disability scores and MRI lesions during follow-up.
As B cells returned after treatment, their characteristics suggested that part of the immune system may have been reset, while existing immunity to a virus was preserved.
However, these are preliminary. The study was small, had no control group and involved only a short-term follow-up. Further research is needed to identify the most appropriate dose and determine the treatment’s long-term safety, effectiveness and whether its benefits last (O135).
BTK inhibitors
Bruton’s tyrosine kinase (BTK) inhibitors are a new class of MS treatment that targets activated immune cells involved in both relapsing and progressive disease. Tolebrutinib is currently the only BTK inhibitor approved in Australia by the Therapeutic Goods Administration (TGA), but others are in development. This drug class may therefore offer a new treatment option for different forms of MS. However, some BTK inhibitors have been linked to raised liver enzymes and drug-induced liver injury, making liver safety an important consideration.
Fenebrutinib improves MRI markers of MS progression
Previously reported phase 3 trials found that fenebrutinib was not inferior to ocrelizumab in primary progressive MS and reduced relapses compared with teriflunomide in relapsing MS.
A new late-breaking analysis examined fenebrutinib’s effects on MRI features associated with progressive MS and disability. These features – slowly expanding lesions (SELs) and paramagnetic rim lesions (PRLs) – are signs of ongoing inflammation in the brain.
Compared with ocrelizumab, fenebrutinib was associated with 21.5% fewer SELs in primary progressive MS. Compared with teriflunomide, it was associated with 18.3% fewer SELs in relapsing MS. The total volume of SELs was also reduced by 27.5% and 30.5%, respectively.
Fewer fenebrutinib-treated participants developed new PRLs. This difference was statistically significant in relapsing MS, but not primary progressive MS.
These MRI findings suggest that fenebrutinib may act on areas of ongoing inflammation linked to progressive disease in both relapsing and progressive MS (0137).
Latest BTK inhibitor remibrutinib – new phase 3 trial results
Late-breaking phase 3 clinical trial results for a new BTK inhibitor, remibrutinib, were presented and published in The Lancet. The REMODEL-1 and REMODEL-2 trials compared remibrutinib with teriflunomide in relapsing MS.
Remibrutinib significantly reduced annualised relapse rates by about 30% and MRI disease activity by 66-70% compared with teriflunomide. A marker of nerve damage in the blood was significantly lower with remibrutinib. Disability progression was delayed at three and six months, with 92% of participants remaining progression-free compared with teriflunomide. Remibrutinib was generally well tolerated, with no liver safety signal identified.
Overall, the results suggest remibrutinib could become an effective oral treatment for relapsing MS, with strong effects on relapses and MRI activity, reduced disability progression and a better safety profile than other BTK inhibitors (0139).
Ofatumumab and siponimod in childhood MS
Treatment options for children with MS are more limited than for adults. The phase 3 NEOS study compared ofatumumab and siponimod with fingolimod in children with MS.
Both treatments were not inferior to fingolimod in reducing annualised relapse rate, meaning they were at least as effective. Ofatumumab reduced annualised relapse rates by 24.8% compared to fingolimod, while siponimod produced a similar relapse rate to fingolimod. Both treatments were also superior to interferon beta-1a.
Ofatumumab significantly reduced MS lesions compared with fingolimod, while the reduction with siponimod was not statistically significant.
Both treatments were generally well tolerated, with safety findings consistent with their established profiles.
Overall, the results support a favourable balance of benefits and risks for ofatumumab and siponimod in children with MS (0138).
Tocilizumab for MOGAD – the TOMATO trial
The phase 3 TOMATO trial evaluated tocilizumab, a treatment that blocks the inflammatory protein IL-6, in people with relapsing myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). There is no currently approved therapy for MOGAD.
The trial included 102 participants: 68 received either tocilizumab plus prednisone and 34 received prednisone alone.
Tocilizumab substantially reduced relapses. Only 9% of participants treated with tocilizumab plus prednisone experienced a relapse, compared to 53% receiving prednisone alone. At the end of the study (52 weeks), 81% of participants in the tocilizumab group were free from both relapses and steroid treatment, compared with 26% on prednisone-only group.
Tocilizumab was also associated with a lower annualised relapse rate, a lower prednisone dose and fewer active MRI lesions. Disability worsened in 4% of participants receiving tocilizumab plus prednisone, compared to 18% receiving prednisone alone.
The overall incidence of adverse events was similar between groups (O134).
Women’s health in MS
Professor Sandra Vukusic, winner of the 2026 Rachel Horne Prize for Women’s Research in MS, delivered the closing lecture, “Three Decades of Women’s Health in MS”. New ECTRIMS Guidelines covering family planning, fertility treatment, pregnancy and breastfeeding in MS were presented and are soon to be published. Guidelines for NMOSD and MOGAD will also be available.
A key message was that women with MS should be supported in their family plans. Exclusive breastfeeding should be encouraged where appropriate and in line with each woman’s wishes.
The goals for MS treatment should be the same for women as they are for men – treat early and effectively. There should be no competition between MS management and motherhood. Pregnancy planning should not unnecessarily delay starting or switching therapies, including using high efficacy therapies where needed. Many therapies are compatible with pregnancy and breastfeeding, especially antibody therapies.
Women should discuss their family plans with their MS healthcare team, which should work closely with other healthcare providers involved in pregnancy care.
Thirty years ago, women with MS were often discouraged from having children. Encouragingly, a large MSBase registry study led by Emmanuele D’Amico found that birth rates among women with MS are now almost three times higher than 30 years ago. Women with MS are also giving birth at older ages than previously, particularly aged 30-34 (O052).
An Australian MRI study led by Professor Vilija Jokubaitis and Dr Jessica Shipley looked at brain changes during pregnancy in women with MS. As in women without MS, there was slight loss of brain volume during pregnancy, but this recovered afterwards. Modern treatment strategies – including continuing therapy throughout pregnancy, receiving ocrelizumab within six months before conception, or continuing natalizumab into the third trimester – were linked to less brain volume loss and better control of MS lesions (O049).
Professor Vukusic also highlighted the significant overlap between the symptoms of menopause and MS. More research is needed to understand the effects of hormone replacement therapy (HRT) in women with MS. Current guidance suggests that HRT may help manage menopausal symptoms and protect bone health. As in the general population, menopause care should address cardiovascular risks, osteoporosis, cancer risk, physical activity, and other factors.
Reassuringly, a large Swedish study led by Katarina Fink found that HRT was not associated with a higher risk of relapses or advanced disability in women with MS. Women with HRT also had better outcomes on some disability milestones (O051).
Women with MS should keep up to date with recommended cancer screening.
Looking ahead
MSToronto2026 highlighted encouraging progress across MS diagnosis, treatment and care, while also showing how much remains to be understood. From earlier diagnosis and emerging therapies to myelin repair and women’s health, the research points towards a future of more precise and personalised MS care. Many findings are still preliminary, but together they offer hope for better outcomes for people living with MS and related disorders.
*Presentation numbers are provided, for reference of those who attended the conference.
