MSNEWS for at least six months), compared to 22.6 % of those on tolebrutinib.
That represents a 31 % relative reduction in the risk of disability worsening.
Tolebrutinib also reduced the number of new or enlarging brain lesions on MRI and slightly improved the chance of disability improvement. However, it did not affect hand function in the nine-hole peg test despite slowing the decline in walking.
While most side effects were mild, serious adverse events were more frequent in the tolebrutinib group( 15 % vs. 10.4 %), including liver-related issues. One participant who experienced severe liver toxicity died following a liver transplant. This occurred before the study added
more frequent liver monitoring, which is intended to detect and manage similar issues early in the initiation of the therapy.
The results are promising for a population of people with MS for whom effective therapies are lacking. Tolebrutinib appears to slow disability progression and brain inflammation in SPMS without active relapses. However, safety concerns— especially liver toxicity— mean careful monitoring would be critical if the drug were to be approved by the US Food and Drug Administration.
Fox RJ, Bar-Or A, Traboulsee A, et al.“ Tolebrutinib in Nonrelapsing Secondary Progressive Multiple Sclerosis.” New England Journal of Medicine. 2025 Apr 8. doi: 10.1056 / NEJMoa2415988.
Most MS Patients Stick With Ketogenic Diet After Study Ends— But In A More Flexible Way
A ketogenic diet( KD) may help improve symptoms in people with relapsing multiple sclerosis( MS), but is the improvement sustainable once a trial ends? Researchers followed 65 participants who completed a 6-month modified Atkins diet intervention to determine whether people stayed on the diet, what benefits they reported, and how their health changed after the trial.
Overall, 91 % of participants had planned to continue the diet after the study, though actual adherence to the diet dropped slightly. Three months after the trial ended, 21 % of participants remained on the strict ketogenic diet, and another 37 % followed a more flexible, liberalized version of it. Those who experienced greater reductions in fatigue and body mass index( BMI) during the trial were more likely to stick with the diet long-term.
People continuing the diet reported sustained benefits, especially concerning energy, weight, and MS-related symptoms like pain, numbness, and balance. At three months post-trial, health outcomes such as fatigue, depression, and physical quality of life remained improved compared to pre-trial levels, although not as strongly as during the diet period. Notably, even those who stopped the diet maintained some positive changes, including healthier eating patterns.
Participants also showed lower levels of inflammatory markers like leptin and increased levels of adiponectin and vitamin D. Cost, social factors, and challenges eating out were the most reported barriers to long-term adherence.
This study suggests that the ketogenic diet may produce lasting health and dietary benefits in people with MS, even outside a controlled clinical trial. However, the impact of KD on the course of MS is relatively unknown. Individualized support and flexible dietary options may be the key to sustaining long-term use.
Wetmore E, Lehner-Gulotta D, Florenzo B, et al.“ Ketogenic diet in relapsing multiple sclerosis: Patient perceptions, post-trial diet adherence & outcomes.” Clinical Nutrition. 2023; 42( 8): 1427-1435. doi: 10.1016 / j. clnu. 2023.04.007.
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