Have you ever wondered why your MS symptoms seem to slowly worsen over time, even when your MRI shows no new changes?
Living with multiple sclerosis (MS) can feel like a rollercoaster—some days are smooth, while others bring unexpected challenges. If you’ve ever felt like your symptoms are quietly worsening, even when your MRI looks stable, you’re not alone. This slow, steady progression—often called “smoldering MS”—is something researchers are working hard to understand and treat.
One area of research that’s generating a lot of excitement is BTK inhibitors. These medications could offer new hope for people with MS by addressing not just relapses but also the underlying processes that cause long-term progression.
By the way, have we met? I’m Dr. Gretchen, a physical therapist and MS-certified specialist who’s spent nearly a decade working exclusively with people living with MS. Through my work, I’ve developed a unique approach to MS strength and conditioning that blends science, practical exercises, and a dash of encouragement to help you feel stronger, more confident, and ready to tackle life head-on. Thousands of individuals with MS have found renewed hope and real progress using these strategies—and you can too.
Today, we’re diving into two promising BTK inhibitors—Evobrutinib and Tolebrutinib—and what they could mean for the MS community.
Let’s start with the basics: BTK inhibitors are a type of medication designed to calm down overactive immune responses in MS.
BTK stands for Bruton's Tyrosine Kinase, which is an enzyme that helps activate certain immune cells. In MS, these immune cells mistakenly attack the brain and spinal cord, causing inflammation and damage.
BTK inhibitors work by targeting these overactive immune cells to reduce inflammation. What makes them especially exciting is their potential to help with two key aspects of MS:
This dual action, combined with it’s ability to cross the blood-brain barrier, could make BTK inhibitors a game-changer for people living with MS.
If you’ve ever felt like your symptoms are slowly getting worse—even when your MRI shows no new lesions—you might be experiencing smoldering MS. This happens because of low-level inflammation in the brain that current treatments don’t fully address.
Most existing MS medications focus on preventing relapses, slowing progression, and stopping visible damage on MRI scans. While these treatments are effective for many people, they don’t always tackle the hidden inflammation driving long-term progression. That’s where BTK inhibitors come in—they’re designed to target both the visible and invisible aspects of MS, offering hope for better outcomes.
Evobrutinib was one of the first BTK inhibitors c studied for MS. It showed promise in early trials by reducing relapses and inflammation in some patients.
Unfortunately, recent results from clinical trials revealed outcomes for Evobrutinib that were not as promising as hoped for:
This was a surprising result for researchers and neurologists who had high hopes for this new class of drugs. However, it's worth noting that Aubagio performed better than expected in these trials, raising questions about its effectiveness compared to prior assumptions.
While Evobrutinib's trial results were disappointing, researchers remain optimistic about other drugs in this class. Not all BTK inhibitors are the same—some may still show promise in addressing both relapses and progression in MS.
Tolebrutinib is another BTK inhibitor making headlines in MS research. Like other BTK inhibitors, it has the ability to cross the blood-brain barrier—a protective shield around the brain—allowing it to target inflammation directly within the central nervous system (CNS).
Tolebrutinib has shown mixed results:
This marks an important step forward for progressive forms of MS—a challenging area where treatment options have historically been limited.
For those living with progressive or smoldering MS—where treatment options are limited—Tolebrutinib could be a breakthrough. Its ability to tackle inflammation deep within the brain makes it uniquely suited for addressing this challenging aspect of MS.
One major way BTK inhibitors stand out is their ability to cross the blood-brain barrier. This feature allows them to address inflammation deep within the brain—a key driver of smoldering MS that many current treatments cannot reach.
In short:
While Evobrutinib is no longer being tested due to its trial results, other BTK inhibitors remain under investigation:
Researchers remain optimistic that one or more of these drugs will prove effective across different types of MS.
While we wait for these treatments to become available, there are steps you can take today:
Stay Informed: Keep up with emerging research on BTK inhibitors and other innovative therapies. As soon as I can provide you with an update, I will be sure to do so.
Talk to Your Doctor: If you’re curious about participating in clinical trials or exploring new treatment options, start a conversation with your healthcare provider.
Advocate for Yourself: If you’re noticing changes in your symptoms—even if your MRI looks stable—don’t hesitate to speak up. Your experiences matter!
Living with MS can be tough, especially when it feels like your symptoms are quietly worsening despite treatment. But advancements like BTK inhibitors remind us that progress is being made every day. Whether it’s through new medications or simply understanding more about how MS works, each step forward brings us closer to better care and brighter futures.
As Dr. Gabriel Pardo once said: “This isn’t something you’re imagining—it’s real.” For those living with smoldering MS or feeling stuck between relapses and progression, know that your experiences are valid—and there’s hope on the horizon.
If you’re looking to find more information about MS treatments, exercises, and a community of fellow warriors, my podcast —The MSing Link—is for you! Together, we will learn top strategies & exercises to gain control of MS using research-driven insights & advice from top industry experts. Most importantly, you’ll feel empowered and hopeful after each episode.
Do you have any further questions on BTK inhibitors and their relation to MS symptom progression? Please feel free to DM on Instagram @doctor.gretchen.
Have you ever woken up to blurry vision, double vision, or an unexplained ache behind your eyes and wondered, what’s happening to me? There are ways to understand, manage, and even improve these vision issues - read the causes of MS-related vision changes andexplore practical ways to manage it here!
Dr. Gretchen Hawley's The MSing Link offers a comprehensive guide to taking control of your MS symptoms and improving your mobility through MS-specific exercises and strategies.
6000+ copies sold in over 13 countries!
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As a physical therapist & Multiple Sclerosis Certified Specialist, I have spent the last 10 years teaching people with MS how to feel more confident & empowered through MS-specific exercises and strategies.
If you want support and encouragement, plus a healthy dose of tough love, come follow me on Instagram (@doctor.gretchen) or on YouTube @DoctorGretchenHawley. It's where I share daily tips, tricks, and information about new offers — plus, you’re bound to feel more empowered, hopeful, & motivated after watching each post and video!
Questions? Email me at Hello@DoctorGretchenHawley.com