The ECTRIMS Podcast

What if clinical trials could evaluate multiple treatment approaches at the same time and adapt as evidence emerges?
In this episode of the ECTRIMS Podcast, host Brett Drummond speaks with Prof. Jeremy Chataway of University College London and Prof. Daniel Ontaneda of Cleveland Clinic about multi-arm, multi-stage clinical trials and their potential to make MS research more efficient and responsive.
The episode comes at an especially timely moment. This week, interim results from the OCTOPUS trial showed that alpha-lipoic acid will progress to the next stage of the trial, while the metformin arm will be stopped. These results provide an early demonstration of the adaptive approach discussed in this episode — although the conversation itself was recorded before the interim results were available.
Together, they discuss:
How multi-arm, multi-stage trials differ from traditional clinical trial designs
Why these approaches could be particularly valuable in progressive multiple sclerosis
How a single trial framework can allow promising treatments to advance while less promising approaches are stopped
The potential benefits for recruitment, participant experience and reducing the time between trial phases
The statistical and practical challenges involved in designing and running these complex studies
How interim outcomes, imaging and biomarkers could help identify promising treatments earlier
What the OCTOPUS trial is investigating — and how its design is being used to evaluate potential treatments for progressive MS
Whether the same approach could be used to accelerate the development of remyelination and repair therapies
As the first OCTOPUS interim results now show, the adaptive design discussed in this episode is not simply theoretical. This episode offers a particularly relevant look at the thinking behind the trial and the methodology being used to determine which treatments should move forward and which should not.
This podcast episode is supported by an educational grant from Alexion, AstraZeneca Rare Diseases, Bristol Myers Squibb, Roche, Sanofi, and UCB. Educational grant providers have no input into the podcast series content.

The blood–brain barrier is a highly specialised interface that regulates the movement of cells, molecules and nutrients between the circulation and the central nervous system.
But what happens when this critical barrier becomes dysfunctional in multiple sclerosis?
In this episode of the ECTRIMS Podcast, host Brett Drummond speaks with Prof. Elga de Vries of Amsterdam UMC and MS Center Amsterdam about the evolving science of blood–brain barrier dysfunction in MS.
They explore how the blood–brain barrier functions in health, how its disruption relates to immune cell infiltration and inflammatory disease activity, and why research increasingly suggests these changes may remain relevant across different stages of MS.
The conversation also looks at innovative blood–brain barrier-on-a-chip models, how existing MS treatments interact with the barrier, and emerging approaches designed to transport therapies more effectively into the CNS.
Finally, they consider an intriguing future direction: could strengthening the blood–brain barrier itself become part of the therapeutic strategy for MS?
This podcast episode is supported by an educational grant from Alexion, AstraZeneca Rare Diseases, Bristol Myers Squibb, Roche, Sanofi, and UCB.

Can growing amounts of real-world MS data help clinicians predict disease progression and make more personalised treatment decisions?
In this episode of the ECTRIMS Podcast, host Brett Drummond speaks with Dr. Will Brown from Cambridge University and Dr. Carmen Tur from CEMCAT about the rapidly evolving field of predictive modelling in multiple sclerosis.
They explore why MS is particularly difficult to predict, from its biological and clinical heterogeneity to the lack of sufficiently sensitive, specific and widely available biomarkers. They also discuss how increasingly rich, long-term datasets are allowing researchers to study disease outcomes, treatment journeys and populations traditionally underrepresented in clinical trials.
The conversation examines the methodological challenges that come with real-world data, including missing data, non-random treatment allocation, clinical outcome selection and bias, as well as the opportunities and limitations of AI and machine learning.
Finally, they ask what must happen before predictive models can enter routine clinical care — including robust external validation, calibration, interpretability, equitable representation and evidence that using these tools actually improves clinical decisions and long-term patient outcomes.
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This podcast episode is supported by an educational grant from Alexion, AstraZeneca Rare Diseases, Bristol Myers Squibb, Novartis, Roche, Sanofi, and UCB. Educational grant providers have no input into the podcast series content.

Technology is opening new possibilities for how multiple sclerosis is monitored, treated and managed.
In this episode of the ECTRIMS Podcast, host Brett Drummond speaks with Prof. Ellen Mowry of Johns Hopkins University and Prof. Letizia Leocani of Vita-Salute San Raffaele University about how innovative medical technologies could transform MS research and clinical care.
Together, they explore:
How artifical intelligence, wearable devices and digital biomarkers could help monitor MS progression
The potential to capture fatigue, cognition, pain, mood, sleep and other symptoms between clinical visits
How passive monitoring could provide a more complete picture of everyday life with MS
The growing role of virtual rehabilitation, digital therapies and other technologies in bringing care into people's homes
Why digital biomarkers require rigorous research and validation before being used in clinical trials
From earlier detection of disability progression to more accessible rehabilitation and personalised symptom management, this episode examines both the opportunities and challenges of using technology to improve MS care.
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This podcast episode is supported by an educational grant from Alexion, AstraZeneca Rare Diseases, Bristol Myers Squibb, Novartis, Roche, Sanofi, and UCB. Educational grant providers have no input into the podcast series content.

Could multiple sclerosis one day be detected before symptoms appear? And if so, should we be actively screening people who are at higher risk?
In this episode of the ECTRIMS–MS Journal collaboration series, host Prof. Anneke van der Walt, Controversies Editor at the Multiple Sclerosis Journal, is joined by Prof. Helen Tremlett (University of British Columbia) and Prof. Ruth Ann Marrie (Dalhousie University) to debate one of the most important emerging questions in MS research.
Helen argues that targeted screening should begin now—but only within carefully designed research studies—to better understand how MS develops before clinical symptoms appear. Ruth Ann argues that while prevention is the ultimate goal, the science, ethics and healthcare systems are not yet ready for widespread screening.
Together they discuss:
·      Whether MS is entering a new era of prevention research
·      What lessons can be learned from Parkinson's disease and radiologically isolated syndrome (RIS)
·      The ethical and psychological impact of identifying people at risk before symptoms develop
·      How screening programmes could improve—or worsen—health inequalities
·      What research is still needed before screening could ever become part of routine clinical practice
Although they argue opposing positions, both experts agree on one important point: preventing MS is an achievable ambition—but only if research proceeds carefully, ethically and equitably.
This MS Journal Controversies article series has been made open access for the next month for ease of reading.
"Yes" – High-risk populations should be screened for MS
"No" – High-risk populations should not yet be screened for MS
"Commentary" – High-risk populations should not yet be screened for MS
Note: This episode is part of the MS Journal Controversies in MS series, where experts debate opposing viewpoints on important unresolved questions in MS research. The positions argued do not necessarily represent the authors' personal opinions, but rather present the strongest evidence supporting each side of the debate.