Multiple Sclerosis CE/CME ACCREDITED Watch Time: 30 mins

touchTALKS Expert perspective on improving patient outcomes in relapsing MS: From current oral disease-modifying therapies to emerging therapeutic options

Prof. Patricia K Coyle reviews how the clinical management of relapsing MS with disease-modifying therapies is evolving and improving patient outcomes.

Video Chapters
Optimal management of relapsing MS: How are DMTs used in clinical practice?

Prof. Patricia Coyle describes the current landscape of available DMTs for the management of relapsing MS.

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Improving the QoL of patients with relapsing MS: How to reduce the burden of symptoms with DMTs

Prof. Patricia Coyle outlines the burden of MS and the potential impact DMTs can have on overall patient outcomes, with a focus on fatigue as one of the ‘invisible’ yet detrimental symptoms to overall quality of life (QoL).

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How will practice change in the near future for patients with relapsing MS based on new clinical data?

Prof. Patricia Coyle explains how oral disease-modifying therapies (DMTs) are becoming an increasingly important option in the evolving, complex management of relapsing MS, and provides an update on emerging treatments and novel approaches.

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Overview & Learning Objectives

In this activity, Prof. Patricia K Coyle, a leading expert in multiple sclerosis (MS), discusses how disease-modifying therapies (DMTs) are currently used in clinical practice for the optimal management of relapsing MS. She highlights the importance of reducing the burden of the often ‘invisible’ symptoms of MS, such as fatigue, on overall patient quality of life, and reviews the latest, potentially practice-changing developments, which could further improve patient outcomes through shared treatment decision making.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, MS specialists, primary care physicians and advanced practice clinicians involved in the management of MS.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Prof. Patricia K Coyle discloses: Consultant fees from Accordant, Biogen, Bristol Myers Squibb, GlaxoSmithKline, Horizon Therapeutics USA, Janssen, Novartis, Sanofi Genzyme and Viela Bio; and grants/research support from Celgene, CorEvitas LLC, Genentech/Roche and Sanofi Genzyme. Consultant relationships terminated with Alexion, Bayer, Celgene, EMD Serono, Genentech/Roche, Mylan and TG Therapeutics; and grants/research support terminated with Actelion, Alkermes, MedDay and Novartis.

Content Reviewer

Dr John Ciotti discloses: Advisory board fees from EMD Serono (Terminated), Genentech (Terminated) and Janssen (Terminated).

Touch Medical Director

Adriano Boasso and Christina Mackins-Crabtree have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 27 April 2022. Date credits expire: 27 April 2023.

If you have any questions regarding credit please contact

Learning Objectives

After watching this activity, participants should be better able to:

  • Summarize the current recommendations and clinical evidence for the treatment of relapsing MS with oral DMTs
  • Assess the impact that the debilitating symptoms of relapsing MS have on quality of life and the potential of DMTs to improve patient outcomes
  • Explain the science behind new and emerging DMTs for the management of relapsing MS and how they can be integrated into clinical practice
Faculty & Disclosures
Prof. Patricia K Coyle

MS Comprehensive Care Center, Stony Brook University Hospital, Stony Brook, NY, USA

Patricia K Coyle, MD, FAAN, FANA, is Vice Chair (Clinical Affairs) and Professor of Neurology, as well as Director of the Stony Brook Multiple Sclerosis (MS) Comprehensive Care Center, NY, USA. read more

She earned her medical degree and completed her residency in neurology at Johns Hopkins University School of Medicine in Baltimore, MD, USA, where she also completed a fellowship in neuroimmunology and neurovirology. Her areas of expertise include MS, neuroimmunology and neurologic infectious disease (in particular, Lyme disease).  

Prof. Coyle has held multiple leadership positions at the American Board of Psychiatry and Neurology, the American Academy of Neurology, the American Neurological Association and the National MS Society. She has served as an adviser to the US Food and Drug Administration and the US Institute of Medicine. Prof. Coyle has received research funding from the National Institutes of Health and the National MS Society, and is actively engaged in studies to understand and treat these diseases.

Prof. Patricia K Coyle discloses: Consultant fees from Accordant, Biogen, Bristol Myers Squibb, GlaxoSmithKline, Horizon Therapeutics USA, Janssen, Novartis, Sanofi Genzyme and Viela Bio; and grants/research support from Celgene, CorEvitas LLC, Genentech/Roche and Sanofi Genzyme. Consultant relationships terminated with Alexion, Bayer, Celgene, EMD Serono, Genentech/Roche, Mylan and TG Therapeutics; and grants/research support terminated with Actelion, Alkermes, MedDay and Novartis.


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Question 1/5
Among your patients with relapsing MS being treated with a DMT, who do you consider to be at highest risk of poor prognosis and may require to switch therapy earlier?

DMT, disease-modifying therapy; MS, relapsing multiple sclerosis.

The Canadian Multiple Sclerosis Working Group lists male gender, age >40 years, non-white ethnicity and the presence of comorbidities as demographic factors that may be associated with a worse prognosis for patients with relapsing MS. Clinicians should be aware of these risk factors so that they can monitor higher-risk patients and act early to switch them to a higher-efficacy DMT.


DMT, disease-modifying therapy; MS, multiple sclerosis.


Freedman MS, et al. Can J Neurol Sci. 2020;47:437–55.

Question 2/5
Your patient, a 42-year-old male, presented over a year ago with blurred vision, fatigue and bowel dysfunction, and was diagnosed with relapsing MS after clinical examination and MRI-detected CNS lesions. He has been adhering to teriflunomide 14 mg daily for the past 14 months, but on examination he shows an increase in disability. An MRI performed 6 months ago did not show any further evidence of disease progression. How would you manage your patient in line with international evidence-based guidelines?

CNS, central nervous system; DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; MRI, magnetic resonance imaging; MS, multiple sclerosis.

The 2018 AAN practice guidelines on the use of DMTs in patients with MS recommend that, for patients who are adherent to their medication and have been on it long enough for it to take full effect, their treating physician should discuss switching to another DMT if, after a year of using a DMT, they have experienced ≥1 relapse, or ≥2 new MRI-detected lesions, or an increase in disability on examination. 


AAN, American Academy of Neurology; DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MS, multiple sclerosis.


Rae-Grant A, et al. Neurology. 2018;90:777–88.

Question 3/5
When following your patient with relapsing MS whose disease activity is stable on a DMT, which of these would you consider clinical red flags for the risk of developing fatigue?

DMT, disease-modifying therapy; MS, multiple sclerosis.

There are multiple causes of fatigue in patients with relapsing MS, including depression, sleep disorders, medication side effects, pain and muscle spasms, and nocturia due to bladder dysfunction. The first step should be to assess whether there are any underlying causes of the patient’s fatigue. It is important that clinicians treating patients with relapsing MS are vigilant for clinical red flags of these secondary causes so that they can be treated to relieve the symptoms of fatigue.


MS, multiple sclerosis.


Tur C. Curr Treat Options Neurol. 2016;18:26.

Question 4/5
Which of the following statements most accurately summarizes the results of the OPTIMUM trial comparing the effects of ponesimod and teriflunomide on patient-reported fatigue in patients with relapsing MS?

MS, multiple sclerosis.

Change in FSIQ-RMS weekly symptom score from baseline to week 108 was a secondary endpoint in the OPTIMUM trial comparing teriflunomide and ponesimod. The results showed that fatigue did not worsen on ponesimod compared with teriflunomide, with least-square mean change in FSIQ-RMS of -0.01 for ponesimod compared with 3.56 for teriflunomide (mean difference: 3.57; p<0.001).


FSIQ–RMS; Fatigue Symptom and Impact Questionnaire–Relapsing Multiple Sclerosis.


Kappos L, et al. JAMA Neurol. 2021;78:558–67.

Question 5/5
A number of BTK inhibitors are in ongoing phase III clinical trials in patients with relapsing MS. Which of these describes their potential mode of action in treating patients with relapsing MS?

BTK, Bruton’s tyrosine kinase; MS, multiple sclerosis; Th, T helper.

BTK inhibitors, which are capable of crossing the blood–brain barrier, target a critical enzyme involved in B cell maturation and the activation of various immune cells, and may modulate B cells, macrophages and microglia.


BTK, Bruton’s tyrosine kinase.


Dolgin E. Nat Biotechnol. 2021;39:3–5.

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