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The 10th Joint meeting of the Americas and European Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS-ECTRIMS)
The following summarizes some of the highlights from Day 3 of MSToronto 2026.
New McDonald criteria increase diagnostic yield
First-line use of anti-CD20 agents: 2 studies
Do GLP-1 agonists have neuroprotective effects?
Obexelimab efficacy and safety
Ofatumumab vs. tocilizumab in MOGAD
Does EBV reactivation trigger MS relapses?
METEOROID trial of satralizumab in MOGAD
Clinical tip of the day
New McDonald criteria increase diagnostic yield
A German study evaluated the impact of the 2024 McDonald diagnostic criteria when applied to a cohort of 102 individuals with a first demyelinating event (Mahmoudi et al. MSToronto 2026;1816). In total, 30.4% met McDonald 2017 diagnostic criteria whereas 57.8% met 2024 diagnostic criteria for MS. Interestingly, the McDonald 2024 criterion of ≥4 regions substantially increased the diagnostic yield whereas the addition of biomarkers (e.g. PRL, CVS) and inclusion of the optic nerve as a fifth topography did not lead to additional diagnoses.
First-line use of anti-CD20 agents: 2 studies
Two new studies report that initiating treatment with an anti-CD20 agent is highly effective in controlling disease activity. In the Phase IIIb ENSEMBLE-LIBERTO trial, 616 treatment-naïve patients (median age 32 years) received ocrelizumab within six months of diagnosis (Bermel et al. MSToronto 2026;927). Overall, 91% were relapse-free and 90% had no disease activity on MRI; the NEDA rate was 75% throughout six years. In addition, 89% had no 48-week confirmed disability progression. In the phase IV AGNOS trial, 119 early MS patients (mean age 28 years) received ofatumumab for 30 months (Hendin et al. MSToronto 2026;2127). ARR over months 6-30 was 0.01. The annualized Gd+ lesion rate was 0 in months 18-30. The extent of brain atrophy was similar to what was seen in healthy controls.
Do GLP-1 agonists have neuroprotective effects?
A database analysis compared MS patients exposed (n=14,300) or non-exposed (n=335,867) to glucagon-like peptide-1 (GLP-1) receptor agonists (Irfan et al. MSToronto 2026;2569). GLP-1 RA users had a higher mean body-mass index (36.7 vs. 29.0 kg/m2), higher rates of obesity (58% vs. 6%) and higher rates of Type 2 diabetes (49% vs. 4%). A matched comparison showed that GLP-1 RA use was associated with a lower rate of relapses requiring acute steroids (2.33% vs. 5.00%), optic neuritis (1.53% vs. 4.02%), demyelinating events (3.58% vs. 6.50%) and gait abnormalities (7.56% vs. 12.76%). GLP-1 RA users also had lower fatigue and depression scores. Similar results were seen in the subgroup of GLP-1 RA users on ocrelizumab.
Obexelimab efficacy and safety
MOONSTONE is a phase II trial of obexelimab, a mAb that targets CD19 and the inhibitory receptor FcγRIIb, in patients with RMS and active SPMS (Okuda et al. MSToronto 2026;1305). A total of 116 patients were randomized to obexelimab 250 mg SC/week or placebo for 12 weeks; 109 entered the 12-week open-label extension. The relapse rate in the continuous obexelimab group was 0.179 with 91.5% relapse-free; 95.5% were free of Gd+ lesions at week 24. Adverse events included UTI, injection site erythema and headache. About 4% developed a Grade 3 infection. A separate analysis found that serum NfL decreases from baseline were 30% at week 16 and 40% at week 24 (Okai et al. MSToronto 2026;1317). Significant reductions were also seen for CXCL13, a B cell chemoattractant; and for serpinA9, a biomarker of axonal integrity.
Ofatumumab vs. tocilizumab in MOGAD
A small real-world study (N=42) compared ofatumumab, an anti-CD20 agent, with tocilizumab, an IL6 receptor blocker, in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) (Fan et al. MSToronto 2026;2053). The relapse-free rates were 77% for ofatumumab (median follow-up 19.5 months) and 88% for tocilizumab. Ofatumumab appeared to be associated with a slightly more sustained remission. EDSS scores were stable in both treatment groups.
Does EBV reactivation trigger MS relapses?
A study of 56 Epstein-Barr virus seropositive MS patients evaluated markers of EBV reactivation (anti-EA IgG) within 30 days of a relapse (Ladeira et al. MSToronto 2026;1685). The EA seropositivity rate was 18.9% at relapse and 13.5% during remission. Mean anti-EA IgG titres were higher during relapse (23.69 vs. 17.32). sNfL levels were similar in EA-seropositive and -seronegative patients. The authors concluded that EBV reactivation does not appear to be associated with an increase in neuroaxonal damage, although elevated anti-EA IgG titres may indicate a link between EBV reactivation and disease activity.
METEOROID trial of satralizumab in MOGAD
The METEOROID study evaluated satralizumab, an IL-6 blocker, or placebo in 132 patients with relapsing MOG antibody-associated disease (MOGAD) (Kumpfel et al. MSToronto 2026;1652). Satralizumab was administered at weeks 0, 2 and 4 and every 4 weeks thereafter. Satralizumab was associated with a 68% lower risk of relapse (9 patients with relapses vs. 24 patients in the placebo group). Satralizumab-treated patients were significantly less likely to require rescue therapy (odds ratio 0.28).
Clinical tip of the day
The timing of vaccines is an important consideration when considering an anti-CD20 agent. Vaccination before vs. after treatment initiation has a 7-fold greater likelihood of a serological response (Zanghi et al. MSToronto 2026;2236). The observational study looked at vaccination timing in 249 patients (mean age 44.6 years) receiving ocrelizumab, ofatumumab or ublituximab. Overall seroprotection was 60.6% at 6 months and 65.9% at 12 months. The timing of vaccination (before vs. during anti-CD20 treatment) was the most important predictor of vaccine response.
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