End MS Forever

Ending MS means no one else hears the words, “you have MS.” There is growing evidence that MS may be preventable. The two main objectives of the END pathway are preventing MS in the general population and identifying MS in its earliest (prodromal) stages to delay or prevent the onset of signs or symptoms, defined as secondary prevention.

What We Know

The cause of MS is not yet known, but progress has been made in identifying factors that increase the risk of developing MS. In learning about them, we can prevent MS before it occurs by limiting exposure to disease risk factors.

Risk Factors for MS

Low levels of vitamin D, adolescent obesity, tobacco smoking, infection with Epstein-Barr Virus (EBV) and a family history of MS have been consistently linked with an increase in MS risk. To date, more than 230 common gene variants have been identified that contribute to MS risk.

Secondary Prevention

The goal is to identify individuals in whom the biologic processes driving MS have begun but who are not yet showing signs and symptoms, including asymptomatic people with MRI findings highly suggestive of MS. This would allow intervention during the prodromal stage of MS. Because we now know that permanent neurological damage can occur even in the earliest stages of the disease, early intervention can make a big difference in quality of life.

What’s Promising

Compelling evidence supports the idea that near-term, public health strategies to prevent MS — including vitamin D supplementation, childhood obesity prevention and Epstein-Barr Virus (EBV) vaccination — may already exist.

Prodromal Period

Evidence supporting an MS prodrome is emerging, particularly as a result of biomarkers. Biomarkers are measurable indicators that provide information specific to each individual’s unique experience with MS. The most advanced fluid biomarker in development is neurofilament light (NfL), which can be monitored with a blood test. Biomarkers like serum NfL are also evolving as possible solutions that could help identify individuals in the prodromal stage of MS.

What’s Next

Screening tools and biomarkers that identify MS in its prodromal period with enough confidence to trigger initiation of DMTs are needed. Because genetics and environmental exposures driving MS risk have mostly been studied in white populations, further studies are needed to determine if these same factors apply to other racial and ethnic groups.