Bruton's Tyrosine Kinase Inhibitors for Multiple Sclerosis Explained by Neurologist

Published 2023-06-28
Is it hype or hope? The Bruton's tyrosine kinase inhibitors have been purported to benefit "smouldering" multiple sclerosis. In this video, I explain how drugs like masitinib, tolebrutinib, evobrutinib, and fenebrutinib work. We review the side effects and data from clinical trials.

2012 masitinib progressive MS pilot study: bmcneurol.biomedcentral.com/articles/10.1186/1471-…
Review of emerging MS therapeutics: www.ncbi.nlm.nih.gov/pmc/articles/PMC4720678/
The role of mast cells on the blood brain barrier: pubmed.ncbi.nlm.nih.gov/26004870/
AB science press release of the phase 2B/3 study on masitinib in progressive MS: www.globenewswire.com/news-release/2020/09/14/2092…
Article on the masitinib from the Barts MS blog: multiple-sclerosis-research.org/2020/09/progressiv…
Abstract from Dr. Vermersch about the phase II trial: cslide.ctimeetingtech.com/msdc2020/attendee/person…
MS news today article on masitinib: multiplesclerosisnewstoday.com/news-posts/2020/09/…
Product label of MASIVET: www.ema.europa.eu/en/documents/product-information…
Tyrosine Kinase Pathway: www.researchgate.net/figure/Schematic-representati…
A diagram showing the potential role of Bruton’s Tyrosine Kinase inhibiting drugs (tolebrutinib, evobrutinib, masitinib) in Multiple Sclerosis: link.springer.com/article/10.1007/s11910-022-01229…
Evobrutinib Efficacy is Maintained Over Two Years in an Open-label Phase II Study Extension in Patients with Relapsing Multiple Sclerosis (4124): n.neurology.org/content/96/15_Supplement/4124.abst…
lacebo-Controlled Trial of an Oral BTK Inhibitor in Multiple Sclerosis: www.nejm.org/doi/full/10.1056/NEJMoa1901981
Safety and efficacy of tolebrutinib, an oral brain-penetrant BTK inhibitor, in relapsing multiple sclerosis: a phase 2b, randomised, double-blind, placebo-controlled trial: www.thelancet.com/journals/laneur/article/PIIS1474…

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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.

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Music: INNER GRACE - Copyright 2018 Wilton Vought Source: Really Really Free Music Link:    • Video   T

he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.

All Comments (21)
  • @AaronBosterMD
    Very nice video. We're actively involved in several of these trials at present.
  • I was part of the evolutionRMS2 study. Evobrutinib vs Aubagio. The center that I was at was absolutely horrible about listening to side effects, and I left for my own safety. I hope others have a better experience in trials. I absolutely recommend doing things for science, but remember that you're your best advocate!
  • @kenguru4795
    I am involved in Gemini I and II. Glad to hear about this topic, thanks for the video. I have been in the trial for 1,5 years, haven't had any relapses since then and since my diagnosis. I was diagnosed two years ago, in my country you can get medicine if you have at least 2 flair ups, so I was happy I could begin taking trial medicine.
  • Thank you Dr Beaber for this high quality information! It's wonderful to have someone who updates us on new information. Also wonderful to go to our Dr. appointments so well informed.
  • @yumpiri
    Great content as always Dr. Beaber. If my MS transitions to the progressive form with no active relapse/lesions I would like to try BTK inhibitors. Hopefully they will show better efficacy against progression than other DMTs✌🏼
  • @luciece
    Thanks Dr Beaber, one of the best video reviews of BTKi I've seen so far.
  • @1nsanetr
    Science will save us. Thanks Dr. Beaber. B cell depletors made a great success. As I see Bruton's Tyrosine Kinase Inhibitors have the potential for another breakthrough. Can't wait for more phase 3 trials.
  • @marij5598
    Currently part of the fenebrutinib study! This video really helped me understand it even better ❤
  • I have been fortunate to study with in my field (music) with some world class innovators. They not only passed on knowledge and skills, but also more inspired me and in a sense made me smarter or more spongelike/receptive and thirstier for knowledge. The realities of the universe are limitless and the status quo and existing arsenal at any time must be constantly be re-born and re-discovered. If a music creator is in the zone ANY moment offers new possibilities the well never runs dry. It should be no different in other fields. Thank you good Dr. Brandon Beaber for delivering this and other videos which explain, the gist , the details, the caveats & confounders, help us (MSers) be inspired more spongelike students. The being hopeful part is ultimately in our personal domain and so, your lack of affectation (though u r passionate and fearless) is appropriate I think for many of us fighting MS whoin the end need to have a positive psychological visualization in bettering our health through the intangible faith like x-factor (whether we are Darwinians, or scripturists or whatever stripe). My HSCT at Ruiz happens this Sept 2023 in Puebla. I didn't have slowed progression on B cell depletion. I'm 59 with PPMS, and this HSCT is not a slam-dunk but I've heard from many (even those with PPMS some even older than me) who have had their progression halted. I'm still with out cane and performing music live and in the studios but progression is not halting, so endless thanks for this and all your work.
  • @MohammedNomer
    Thank you so much sir !! You are a wonderful person bless your soul, may your days be always prosperous and healthy
  • @jasonpl4548
    Thanks for the video! Has me excited! I have also heard about imu-838 being in late stage trials and showing protection against smoldering. Would love a video about it! Thanks again!
  • Hey Doc! Thank you for the great content as always! I was diagnosed with probable MS after my first attack of ascending numbness up to right around my chest + positive Lhermitte’s. MRI showed 12-14 small lesions in the brain ( some enhancing ) and one lesion in the cervical spine. After 1 week of Solumedrol, my CSF came back positive for Lyme (elisa) and they started me on Ceftriaxone for 3 weeks. Everything resolved within 2 months except a bit of Lhermitte’s and internal tremors after running/walking. 3 years fastforward, I had another attack - exact same symptoms but this time I took no medication and it resolved within 3 months . (No change in my MRI of head and cervix) My neuro prescribed hypothalamus phospholipids alongside high dose B1+6+12 shots for 10 days due to my reluctance to start on DMDs. I understand you cannot provide medical advice but any comments/thoughts would be highly appreciated! I am 26 male and very worried for my health! Please, let me know if you provide paid online consultations! I would so love for you to be my neuro! I live in Azerbaijan and we have no MS specialists here.
  • @hackett1181
    Thanks for the great explanation! I’m hoping for the best for BTK inhibitors. I’m one of those older people who needs something besides an immune suppressor DMT.
  • Thanks so much Dr. Beaber. It is so encouraging that there may be another option soon for people with MS. Could you do a video explaining the difference between smoldering MS (PIRA) and SPMS & PPMS?
  • @donnabolt5847
    Any new updates on the stemcell transplant trials? I applied for the one in San Diego and am waiting for the next step after Dr Burt requested my actual MRIs to review. My ms neuro said in the most recent journal that the results are coming in to be not much better than the big gun DMTs what are your thoughts? Love these kind of videos! Ive been rooting for DKT. The Primary progressive warriors really NEED help!! THANK YOU!!
  • Good and informative video as always! 🙏 I have been on a clinical trial Evobrutinib against Tecfidera for nearly 2 years 2017-2019, no major side effects, maybe some bloating if I recall correctly, but I got one nasty relapse in that period. The good thing was that on MRI one of my lesions had disappeared.
  • @katyballard7813
    Thank you for this information! I wasn't able to join a BTKi trial because my lymphocyte count was just under the requirement after 9 years on Gilenya. I've had MS for 24 years and I'm looking forward to BTKi or other therapies that will target smoldering MS. I'd love to learn more about how infections may activate MS and induce activity. Last year after a mild case of COVID-19, my MRI showed an enhancing lesion for the first time in more than 12 years, though I wasn't having specific symptoms of a relapse.