The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2025  congress, held in Barcelona, Spain, welcomed over 9,600 attendees from 120 countries, marking the world’s largest annual meeting in MS research and clinical practice.

Under the theme “A New Era of Precision,” the meeting showcased how advances in biomarkers, novel therapeutics, cognitive monitoring, and lifestyle medicine are driving increasingly personalized care for people with MS. This article highlights some of the key advances presented at ECTRIMS 2025.

This article has been produced in collaboration with the National Multiple Sclerosis Society, based on their meeting highlights available here.

Therapeutic innovation: Precision in disease control

Ocrelizumab expands its reach in progressive MS

New data from the Phase IIIb ORATORIO-HAND study demonstrated that ocrelizumab significantly delayed disability progression and preserved hand and arm function in individuals with primary progressive MS (PPMS), including older adults and those with advanced disability.

The findings, presented by Dr Gavin Giovannoni (Queen Mary University of London, UK), confirm ocrelizumab’s efficacy even in patients who use wheelchairs, extending its clinical utility beyond early PPMS cohorts and supporting its potential to maintain independence.¹

Ocrelizumab demonstrates superior efficacy in paediatric-onset MS

© ECTRIMS 2025

Dr Brenda Banwell (Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA) presented results from the Phase 3 OPERETTA 2 trial, evaluating ocrelizumab versus fingolimod in 187 patients aged 10–17 years with paediatric-onset multiple sclerosis (POMS), a condition accounting for 3–5 % of MS cases worldwide.

Ocrelizumab significantly reduced relapse rates and the number of new or enlarging lesions compared with fingolimod. Participants will continue in long-term follow-up to assess ongoing safety and durability of response, supporting ocrelizumab’s potential as a future treatment for POMS.²

Abstracts:
1. Ocrelizumab vs. placebo in primary progressive MS: efficacy and safety results of the Phase IIIB ORATORIO-HAND study
2. Efficacy and safety of ocrelizumab compared with fingolimod in paediatric relapsing-remitting MS: results of the Phase III OPERETTA 2 study 

BTK inhibitors: A new frontier in MS therapy

A new therapeutic class, Bruton’s tyrosine kinase (BTK) inhibitors featured prominently at ECTRIMS 2025. These agents act on B cells and microglia, targeting the drivers of inflammation and progression independent of relapses.

Tolebrutinib, now under FDA and EMA review, showed promising results in the previously reported HERCULES trial. Dr Robert Fox (Mellen Center for Multiple Sclerosis at Cleveland Clinic, Cleveland, OH, USA) presented data showing that tolebrutinib had a favourable treatment effect compared to placebo in different subgroups of participants, demonstrating that tolebrutinib effectiveness did not significantly differ based on age, sex, or country.³

Dr Patrick Vermersch (University of Lille, Lille, France) reported on a study investigating tolebrutinib. The results showed that over 2 years, people with non-relapsing secondary progressive MS (nrSPMS) showed small but meaningful improvements in physical and mental health scores, suggesting that tolebrutinib may help preserve day-to-day functioning.⁴

Fenebrutinib showed promising results in the Phase 2 FENopta study by significantly reducing new or enlarging brain lesions in individuals with relapsing-remitting MS. New 2-year follow-up data presented by Dr Jiwon Oh (St. Michael’s Hospital, University of Toronto, Canada) further indicate that participants who continued on fenebrutinib maintained near-complete suppression of disease activity. These findings support the ongoing large-scale clinical trials designed to assess its long-term safety and effectiveness.⁵

Together, BTK inhibitors represent a promising approach for progressive, non-relapsing forms of MS.

Promoting myelin repair in RRMS

Results from a Phase II trial combining metformin and clemastine, two existing drugs for diabetes and an antihistamine respectively, showed evidence of improved myelin repair in relapsing–remitting MS (RRMS), measured via visual-evoked potentials. While no short-term improvements in disability were observed, researchers emphasized the importance of longer trials to translate these early neurobiological gains into functional benefits.⁶

Abstracts:
3. Subgroup Analyses of the Phase 3 Tolebrutinib in nrSPMS HERCULES Trial
4. Effects of Tolebrutinib on MSQoL-54 in the HERCULES Phase 3 trial in nrSPMS
5. Fenebrutinib maintains early and sustained low disease activity in patients with relapsing multiple sclerosis: 2-year results from the FENopta open-label extension
6. Evaluating the remyelinating efficacy and safety of the combination of metformin and clemastine in people with relapsing remitting multiple sclerosis (CCMR-Two)

Diagnosis, prediction and markers of MS

© ECTRIMS 2025

Real-world applications of diagnostic criteria

The 2024 McDonald Criteria enable earlier and more sensitive diagnosis compared to the 2017 version.⁷ Assessing people with suspected MS, separate studies by Dr Luca Bollo (CEMCAT, Barcelona, Spain) and Dr Wallace Brownlee (UCL Institute of Neurology, London, UK), reported that diagnosis rates rose when the new criteria were used (50% vs 72% and 63% vs 80%, respectively) and time to diagnosis was reduced by up to half.^8,9

Proteomic biomarkers suggest pre-symptomatic phase of MS

Ground-breaking proteomic research identified biomarkers of myelin damage and axonal injury detectable six to seven years before symptom onset. These findings, presented by Dr Ahmed Abdelhak (University of California, San Francisco, CA, USA) suggest evidence of prodromal (pre-symptomatic) phase and could pave the way for screening strategies that identify individuals at highest risk before clinical manifestation.¹⁰

While more research is needed, these results show that blood protein markers might help pinpoint people at risk for MS years before they show symptoms.

Abstracts:
7. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria
8. Impact of the 2024 McDonald criteria revisions on multiple sclerosis diagnosis: a comparison with the 2017 criteria
9. Real-world validation of the 2024 McDonald criteria in patients under evaluation for suspected multiple sclerosis
10. Serum Proteome Changes Unravel Timing of CNS Injury and Involved Pathways in Pre-symptomatic Multiple Sclerosis

Cognition and MS

Cognition and neuroprogression

Cognitive decline took centre stage at ECTRIMS 2025, with Dr Maria Pia Amato (Italy) urging equal clinical attention to cognitive and physical domains.

Dr Elisa Colato (MS Center Amsterdam, Amsterdam, Netherlands) presented a study using an unsupervised machine-learning approach applied to longitudinal cognitive test data from nearly 3,500 people with multiple sclerosis, the researchers identified four distinct cognitive-phenotype progression patterns, each with unique trajectories and implications for personalized monitoring and intervention.¹¹

Seeing cognitive decline as an early marker of disease

While standard clinical tests for MS progression centre on physical disability, Dr. Ela Zengin (Medical Point Hospital, İzmir University of Economics, İzmir, Türkiy) displayed new research suggestive of an earlier warning sign: cognitive changes.

The five-year study of 235 MS patients revealed that noticeable decline in cognitive function often emerged over a year before any physical disability was detected. This highlights the urgent need to incorporate routine cognitive assessment into MS patient care, as it may be the earliest clinical marker of disease progression.¹²

Cognitive decline without relapses

Dr Tom Fuchs (MS Center Amsterdam, Amsterdam, Netherlands) presented research showing 62% of cognitive decline in relapsing-remitting MS happens independently of relapse activity. This “cognitive PIRA” concept could become a helpful new measure for evaluating MS treatments and monitoring overall disease activity.¹³

Abstracts:

11. Identifying cognitive phenotypes and their progression patterns in multiple sclerosis using a machine learning model
12. Cognitive Decline as the First Sign of Progression in Multiple Sclerosis: A Comparative Analysis of Cognitive and Physical Decline
13. Cognitive progression independent of relapse in multiple sclerosis: multi-center characterization 

Lifestyle and Neuroprotection

Ultraprocessed foods and MS

Dr Gloria Dalla Costa (Harvard T.H. Chan School of Public Health, Boston, MA, USA) presented new evidence from a trial investigating betaferon in participants with clinically isolated syndrome (the initial inflammatory episode indicative of multiple sclerosis) . Researchers observed that a high intake of ultra-processed foods was linked to a greater number of relapses and to larger and more numerous active lesions.¹⁴

The MIND diet

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet – which promotes brain-healthy foods like vegetables, nuts, and fish while limiting sugar, unhealthy fats, and processed foods – may support cognition and brain health. In a six-year UK MS Register study, Dr Maggie Yu (Melbourne School of Population and Global Health, Melbourne, Australia) found that greater adherence to the MIND diet was linked to lower disability and fatigue, and improved quality of life in people with MS.

While these results are encouraging, further research, such as an ongoing randomized controlled trial funded by the National MS Society trial, is needed to confirm the long-term benefits.¹⁵

Exercise and myelin repair

Dr Lindsey Wooliscroft (Oregon Health & Science University, Portland, OR, USA) shared early results from a trial of 32 participants, comparing a six-month aerobic exercise programme with a control group. Those who exercised for 30 minutes, three times per week, showed measurable increases in myelin repair in affected brain regions and improved fitness. Though small and short term, the study provides promising biological evidence that exercise may help promote myelin repair in MS.¹⁶

Abstracts:
14. Association of Ultra-Processed Food Intake with Increased MS Disease Activity: Findings from the BENEFIT Trial
15. Adherence to the MIND diet is associated with reduced disability and fatigue and improved quality of life in people with multiple sclerosis: a 6-year longitudinal analysis from the UK MS Register
16. Does aerobic exercise promote remyelination in multiple sclerosis? Pilot data from a single-blind, parallel group randomized controlled clinical trial.

Women’s health and MS progression

Menopause and MS

Dr. Yasemin Şimşek (Medical Point Hospital, Izmir University of Economics, Izmir) analyzed around 600 people with MS to compare symptoms and comorbidities before and after menopause. Initial symptom sites differed, optic pathways were more often affected pre-menopause, while spinal cord involvement was more common post-menopause. Post-menopausal participants also showed higher rates of cardiovascular comorbidities compared with predominantly psychiatric conditions (such as depression and anxiety) before menopause. These findings suggest that hormonal transitions may influence both disease manifestation and comorbidity profiles, underlining the importance of menopause-specific considerations in MS management.¹⁷

Dr. Riley Bove (UCSF Weill Institute for Neurosciences, San Francisco, CA, USA) found that menopause did not affect MS-related brain structures but was linked to faster volume loss in regions tied to cognition. The findings suggest hormone-related changes may influence cognitive function in MS.¹⁸

Abstracts:
17. Impact of Menopause on Initial Clinical Presentation and Comorbidities in Women with Multiple Sclerosis: A Comparative Study with Age-Matched Men
18. MRI substructure volumes demonstrate altered rate of change in post-menopausal participants with multiple sclerosis in a prospective longitudinal cohort

Conclusion

© ECTRIMS 2025

ECTRIMS 2025 reinforced a paradigm shift in MS research, from disease suppression to precision, prevention, and repair. As molecular insights merge with digital diagnostics, behavioural science, and equitable access efforts, the goal of truly individualized MS care moves ever closer.

Through continued collaboration with organizations such as the National Multiple Sclerosis Society, the MS community continues to transform these advances into actionable improvements for people living with MS worldwide.

Related content

© ECTRIMS 2025

• Extending rituximab dosing intervals in MS: Pivotal data from the RIDOSE-MS trial
• Integrating imaging and biomarkers in the revised McDonald criteria
• New McDonald criteria revisions: 6 key updates

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