This US-based key opinion leader (KOL) opines on the current treatment landscape in multiple sclerosis (MS). The KOL discusses the classification of MS patients across clinical subtypes and the notably high treatment rates in the US compared to other regions, driven by broader indications and evolving clinical mindset. The KOL addresses the significant impact of health insurer coverage and PBMs on treatment initiation, highlighting how prior authorization requirements and step-edit protocols delay access to high-efficacy therapies by three months or more. The KOL provides a detailed breakdown of anti-CD20 market dynamics, including the dominance of Kesimpta over Ocrevus in his region due to formulary preferences, alongside commentary on the growing role of Zunovo in PPMS. He also covers platform therapy erosion, S1P class usage, non-responder rates among first-line generics, and BTK inhibitor pipeline challenges, specifically tolebrutinib's regulatory setbacks. The KOL identifies frexalimab as the most promising pipeline molecule and highlights unmet needs in progressive MS, symptom management, and reparative therapies.  

This interview was conducted on February 17, 2026. 

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