“We now define MS as a single disease entity, regardless of clinical presentation”
Prof. Marcello Moccia is a neurologist and Assistant Professor at the University of Naples Federico II, Italy. His work focuses on multiple sclerosis (MS), neuroimaging, and biomarker research, with an emphasis on translating scientific advances into real-world clinical practice. At EAN 2025, Prof. Moccia shared his perspective on the evolving McDonald criteria, the role of advanced imaging and fluid biomarkers, and the exciting innovations reshaping MS diagnosis and management.
1. How do the revised McDonald criteria influence decision-making when initiating disease-modifying therapies (DMTs)?
Diagnostic criteria doesn’t change prescription rules directly, but they can profoundly influence how we approach and how we think about the disease. With the latest revision of the McDonald criteria, we now define MS as a single disease entity, regardless of clinical presentation. This shift means we focus more on disease mechanisms, which can provide insights into severity and risk of progression. For instance, the kappa free light chain (KFLC) index provides a quantitative marker of intrathecal inflammation, that is deeply associated with disability progression over time. Similarly, paramagnetic rim lesions, though used in a minority of cases, can identify patients at higher risk of progression. Altogether, these advances enhance our capacity for precision medicine and early intervention to prevent long term disability.
2. Have the new criteria impacted treatment stratification or clinical outcomes?
We’re still early in the process, so it’s too soon to fully assess the long-term effects of the new criteria. However, looking at the impact of previous revisions, particularly those introduced during the MRI era, we’ve seen significant improvements in MS stratification and earlier identification of those at risk.
In my view, the new set of criteria will continue this trend, allowing even earlier diagnosis, and therefore earlier treatment. And in MS, as in many neurological diseases, timing is everything, early diagnosis means early treatment, and early treatment helps prevent disability.
3. What impact have the criteria had on multidisciplinary care pathways, such as monitoring, neurorehabilitation, and referrals?
MS has always been a multidisciplinary disease. While the neurologist and MS specialist are central to care, they’re not the only provider. With the implementation of the KFLC index, we’ll rely more on laboratory services. We’ll also need closer collaboration with neuroradiologists, particularly for detecting central vein signs and paramagnetic rim lesions, which require specific MRI sequences. Over time, newer biomarkers and definitions of progression will continue to evolve, further shaping multidisciplinary care models and optimising individualized treatment strategies.
4. What current innovations in MS excite you most, and any highlights from EAN 2025?
The session on the new diagnostic criteria was quite exciting. It outlines a clearer path forward in understanding disease mechanisms, improving prognosis, and improving outcomes for people with MS.
I also moderated a poster session, and there’s a lot of promising data. For instance, we’re seeing long-term safety and efficacy updates on existing therapies in clinical practice, which is reassuring for patients doing well on those treatments. We’re also seeing new medications expected to reach the market soon, with emerging data on their mechanism of action and biomarker activity.
Finally, there are some posters on clinical and laboratory biomarkers that are gaining traction, offering the quantitative tools we need to match patients with the specific therapies at the right time.
Presentation at EAN 2025: Impact of new criteria on treatment and routine clinical practice, part of the session: EAN/ECTRIMS: Advances for faster and improved diagnosis in Multiple sclerosis: New revised McDonald criteria
Interviewer: Caroline Markham, Head of Partnerships.
Editor: Katey Gabrysch, Editorial Director.
Disclosures: No funding was received in the publication of this article.
This content has been developed independently by Touch Medical Media for touchNEUROLOGY. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Cite: New McDonald criteria elevate role of biomarkers in MS diagnosis: Marcello Moccia, EAN 2025. touchNEUROLOGY. 23 June 2025.
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