308. Fenebrutinib and BTK Inhibitors: The MS Treatment Everyone's Asking About

Your MRIs look stable… your neurologist says everything looks good… but your walking feels harder and fatigue hits sooner. If that sounds like your multiple sclerosis (MS), this episode is for you.

I’m joined by Dr. Jiwon Oh, MD, PhD, neurologist, MS researcher, and Medical Director of the Barlo MS Program at St. Michael’s Hospital in Toronto, where her team cares for over 12,000 people living with MS. We talk about BTK inhibitors, a new class of MS medications, and what the latest fenebrutinib clinical trial results could mean for people with relapsing MS and primary progressive MS (PPMS).

Here’s what we cover 🔑:

What are BTK inhibitors? BTK (Bruton’s tyrosine kinase) is an enzyme that helps B cells, a type of immune cell involved in MS, mature and multiply. BTK inhibitors are small molecules that can cross the blood-brain barrier (the protective filter around your brain and spinal cord). That means they may reach immune cells inside the central nervous system, like microglia (the brain’s own immune cells), which researchers believe help drive slow progression.

Why “stable” MRIs don’t always tell the whole story. Many current disease-modifying therapies (DMTs) do a great job controlling relapses and new lesions. But some people with MS still notice slow changes in walking, energy, or daily function. Dr. Oh explains why this is real and why researchers are so focused on it.

Fenebrutinib trial results. In two relapsing MS trials, fenebrutinib reduced relapses by over 50% compared to teriflunomide. In a PPMS trial, it was non-inferior to (meaning not worse than) ocrelizumab, currently the only approved treatment for PPMS.

How fenebrutinib compares to other BTK inhibitors. Why evobrutinib, tolebrutinib, and fenebrutinib have shown different results, even though they’re in the same drug family.

When might fenebrutinib be available? What the regulatory approval process looks like, plus what liver enzyme monitoring may involve.

Should you join an MS clinical trial? Who Dr. Oh would consider for a BTK inhibitor, and how to weigh joining a trial (like one for remibrutinib) versus waiting.

This episode is for you if:
✅ Your MRIs are stable, but you feel like your MS is slowly progressing
✅ You have primary progressive MS and want to know what treatments may be on the horizon
✅ Your neurologist mentioned a BTK inhibitor clinical trial and you’re not sure what to do
✅ You want to understand the latest MS research in plain language

Research can feel confusing… especially when it’s about medications and clinical trials. My hope is that this episode helps you walk into your next neurology appointment with clearer questions and a little more hope. 🧡

Resources mentioned in this episode: 

Full Study on fenebrutinib - https://www.biospace.com/press-releases/roches-fenebrutinib-significantly-reduced-relapses-versus-standard-of-care-to-approximately-one-every-17-years-in-rms

About Dr. Jiwon Oh 

 Dr. Jiwon Oh, a medical director at the Barlo MS Program in Toronto, Canada, where her team cares for over 12,000 people living with multiple sclerosis. She's also a leading MS researcher, running clinical trials and MRI research studies aimed at understanding MS progression.

Where to reach Dr. Jiwon Oh:

MS Canada - https://mscanada.ca/ms-research/our-research-program/dr-jiwon-oh

Genetech - https://www.instagram.com/genentech/?hl=en

This episode is for educational purposes only. Always talk with your neurologist before making any changes to your MS treatment.

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