Treatment Of Multiple Sclerosis Research Articles

The mechanism of action of anti-CD20 monoclonal antibodies used in the treatment of multiple sclerosis

CD20 is a transmembrane molecule located on the surface of a major population of cells belonging to the B lymphocyte lineage. Although the significance of this protein remains unknown, the presence of CD20 is a marker for mature circulating B cells. Monoclonal antibodies against CD20 are able to quickly and effectively eliminate circulating B lymphocytes. Four different anti-CD20 antibodies have been studied in the treatment of multiple sclerosis: rituximab, ocrelizumab, ofatumumab and ublituximab. Although all these monoclonal antibodies bind to the same protein, they have different molecular and pharmacological characteristics. One of the important differences between these molecules is the degree of humanisation of their molecular structure, as well as the mechanism of B cell removal. Phase III multicentre clinical trials conducted with each of these antibodies consistently confirmed that the elimination of B cells is an effective method of slowing down the progression of multiple sclerosis. Thus, B cells are considered as main group of immune cells involved in the development and course of multiple sclerosis. Numerous in vitro and in vivo data confirm the involvement of these cells in the pathogenesis of multiple sclerosis, despite the lack of evidence for the presence of pathogenic autoantibodies in this disease. Nevertheless, B cells represent a mixture of cell populations with different immunomodulatory properties. Therefore, future multiple sclerosis therapies should target the pathogenic groups of B lymphocytes, rather than non-selectively eliminating the entire population of these cells.

Safety profile and adherence to treatment with ocrelizumab in multiple sclerosis – long-term observations

Among the available disease modifying drugs used in the treatment of multiple sclerosis, there is an increasing relevance of high-efficacy therapies recommended for early use to control the disease activity effectively. In the course of treatment, efficacy as well as safety measures of high-efficacy therapies have to be regularly evaluated. Ocrelizumab, an anti-CD20+ antibody, is the only high-efficacy therapy approved for the treatment of both relapsing-remitting and primary progressive type of multiple sclerosis. Consequently, the drug can be used in a wide population of multiple sclerosis patients. Recently, the cumulative data have been acquired from 10-year follow-up of ocrelizumab use in clinical trials and real-world evidence in as many as 300,000 patients with multiple sclerosis. Based on these data, the general safety profile of the drug has been reviewed (considering the risk of major adverse events, including infusion-related reactions, infections and malignancies), along with specific aspects associated with vaccines and pregnancy/post-partum period. Moreover, the indices of adherence and persistence in long-term treatment with ocrelizumab have been analysed, together with their potential contributing factors. The above data indicate that treatment with ocrelizumab has a beneficial safety profile and is well-tolerated by patients with multiple sclerosis, which supports the choice of ocrelizumab as a therapeutic option. Ongoing clinical and observational trials and registries will provide further data on the safety of the drug, which would allow an update of recommendation in this field.

The role of ocrelizumab in recommendations and in the Polish therapeutic programme

Multiple sclerosis is a heterogeneous and chronic disease, and the primary goal of treatment is to prevent relapses and slow the progression of disability. Ocrelizumab is a generally well-tolerated disease-modifying therapy for multiple sclerosis, with high efficacy in the treatment of active relapsing forms, and a valuable treatment method for delaying the progression of the disease in patients with the primary progressive form. The activity of relapsing multiple sclerosis is defined on the basis of the clinical course of the disease or radiological findings assessed over a year. The occurrence of clinical relapses and/or activity on magnetic resonance imaging is taken into account. In line with the recommendations of the European Committee for Treatment and Research in Multiple Sclerosis and the European Academy of Neurology, as well as in accordance with the guidelines of the American Academy of Neurology, updated in 2021, depending on the disease activity in the early stage of multiple sclerosis, the choice of a disease-modifying drug should be motivated by higher efficacy. Recommendations for the treatment of multiple sclerosis in most countries in Europe and around the world are based on the above-mentioned guidelines. In Poland, recommendations for treatment modifying the course of multiple sclerosis were developed in 2023 by experts from the Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society. Treatment based on the B.29 drug programme of the National Health Fund in Poland allows, from 1 July 2023, in addition to escalation, using the induction model based on highly effective therapies as first-line treatment.

New directions in ocrelizumab therapy in multiple sclerosis: higher doses and subcutaneous therapy

Ocrelizumab is the first anti-CD20 monoclonal antibody approved for the treatment of relapsing and primary progressive multiple sclerosis. Ocrelizumab is administered intravenously (i.v.) at a dose of 600 mg every six months. It is a highly effective drug strongly inhibiting inflammatory changes in the central nervous system, which nearly completely prevents the development of new active magnetic resonance imaging lesions and clinical relapses. Pharmacokinetic studies and data from post hoc analyses of ocrelizumab pivotal studies suggest that a higher dose than the current dose level might have a stronger therapeutic impact. These results revealed that higher ocrelizumab exposure dependent on lower body mass correlated with increased B cell depletion and reduced risk of disability progression independent of relapse activity (PIRA). In addition, higher ocrelizumab exposure showed a correlation with decreased development of new and enlarging T2 magnetic resonance imaging lesions. Two randomised studies are currently under way to compare the efficacy and safety of the standard i.v. dose of 600 mg versus higher doses (1,200 mg or 1,800 mg) in multiple sclerosis patients. Another new direction in the development of ocrelizumab therapy in multiple sclerosis is subcutaneous (s.c.) drug administration. Recent data from the OCARINA study revealed that s.c. ocrelizumab was not inferior to the i.v. administration with respect to pharmacokinetics, magnetic resonance imaging activity, and clinical relapses. The safety of s.c. ocrelizumab was found to be comparable to the i.v. form, with a higher rate of mild local injection reactions.

Potential therapeutic applications of targeting signal-transducing adaptor protein-2 in autoimmune diseases

Adaptor proteins are involved in various immune responses via the modulation of many signaling pathways. Signal-transducing adaptor protein-2 (STAP-2) is an adaptor protein that contains typical domains such as the pleckstrin homology (PH) domain, Src homology domain, and a proline-rich region from the N-terminal region. In T cells, STAP-2 positively regulates T cell receptor (TCR)-mediated signaling by associating with CD3ζ immunoreceptor tyrosine-based activation motifs (ITAMs) and lymphocyte-specific protein tyrosine kinase (LCK). Therefore, a peptide that inhibits the interaction between STAP-2 and CD3ζ ITAMs is likely to suppress TCR-mediated T cell activation, as well as T cell-mediated diseases. As expected, the peptide successfully inhibited the STAP-2/CD3ζ ITAM interaction and suppressed TCR-mediated signaling, cell proliferation, and interleukin (IL)-2 production in human/murine T cells. Furthermore, this inhibitor suppressed the pathogenesis of experimental autoimmune encephalomyelitis (EAE), which is widely recognized as a mouse model of multiple sclerosis, via the downregulation of T cell activation and infiltration of T helper (Th) 1/Th17 cells. These results suggest a new strategy for the treatment of multiple sclerosis and other immune diseases.

Beliefs about Medicines and the Level of Intentional Non-Adherence to Treatment among Patients with Multiple Sclerosis Treated with First-Line Drugs.

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system. MS has no curable disease but drug modifying therapy (DMT) can delay the long-term disability progression of the disease. The effectiveness of MS treatment depends on the patient's adherence to therapy. This study evaluated the level of intentional non-adherence and the relationship between beliefs about medication and the level of intentional non-adherence to treatment of patients with multiple sclerosis. A group of 146 patients with relapsing-remitting MS were included. To assess different aspect of adherence, the Intentional Non-Adherence Scale (INAS) was used. For evaluating patients' beliefs and opinions regarding medication, the Beliefs about Medicines Questionnaire (BMQ) was used. The mean total INAS score was 51.41 ± 27.83 points. Patients were most concerned about the necessity to take medication and least concerned about the harm caused by medication. The overuse and harm domains of the BMQ were significantly correlated with INAS scores (p < 0.05). Independent determinant of intentional non-adherence was overuse.

A case of acute invasive fungal sinusitis in an immunocompetent patient on glatiramer acetate therapy

Acute invasive fungal sinusitis (AIFS) is a rapidly progressing, life-threatening infection. The advent of immunomodulatory therapies has expanded the population susceptible to AIFS. In this case report, we describe a patient who defies the conventional profile of AIFS. This 70-year-old woman is immunocompetent and non-diabetic, with a history of multiple sclerosis (MS) and ongoing treatment with glatiramer acetate (GA), immunomodulator. She came to the emergency room due to acute vision changes, and images revealed an enhancing mass in the left pterygopalatine fossa. The diagnosis of AIFS was confirmed by biopsy in the operating room. Subsequently, anti-fungal therapies were initiated with a follow-up operative debridement. Follow-up magnetic resonance imaging (10 months since treatment) showed no progression of AIFS. GA was discontinued since the diagnosis, and MS has remained stable. Recognizing this unique group of atrisk patients is crucial, as early detection and treatment play a pivotal role in preventing significant morbidity and mortality.

Stretching is not essential for managing MS spasticity: A randomized controlled trial

Background: Clinical practice, expert opinion, and evidence-based guidelines recommend daily stretching as first-line treatment for multiple sclerosis (MS) spasticity, but this has not been evaluated by fully powered clinical trials. Objective: To determine whether MS Spasticity: Take Control (STC), a guideline-based program of spasticity education and stretching exercises has different effects on the impact of spasticity than a control program of different spasticity education and range of motion (ROM) exercises. Methods: Ambulatory people with self-reported MS spasticity were randomly assigned to STC or ROM, delivered in same duration, facilitator-led, group classes, face-to-face (F2F) initially and later virtually, due to coronavirus disease 2019 (COVID-19). Multiple Sclerosis Spasticity Scale (MSSS) scores were compared between groups at 1 (primary outcome) and 6 months after interventions. Results: A total of 231 people enrolled. There was no significant difference in MSSS scores between STC and ROM at 1 month (mean difference = 0.28, 95% (confidence interval (CI)) = [−9.45 to 10.01], p = 0.955). There were significant group mean improvements in MSSS scores and most other outcomes at 1 and 6 months. Conclusion: Education with stretching exercises, the first-line recommended treatment for MS spasticity, and education with ROM exercises may both improve MS spasticity to a similar degree. This study debunks the belief that stretching is essential to managing MS spasticity.

Hepatotoxicity case due to interferon beta-1a use

Interferon β-1a is an immunomodulatory drug widely used in the treatment of multiple sclerosis. Liver dysfunction is a common side effect of this drug and usually develops within the first 6 months of starting interferon therapy. Here, we present our case who developed hepatotoxicity secondary to interferon β-1a treatment.

Comparing the Pathology, Clinical, and Demographic Characteristics of Younger and Older-Onset Multiple Sclerosis.

Older people with multiple sclerosis (MS) have a less active radiological and clinical presentation, but many still attain significant levels of disability; but what drives worsening disability in this group? We used data from the UK MS Register to characterize demographics and clinical features of late-onset multiple sclerosis (LOMS; symptom onset at ≥50 years), compared with adult-onset MS (AOMS; onset 18-49 years). We performed a pathology study of a separate MS cohort with a later onset (n = 18, mean age of onset 54 years) versus AOMS (n = 23, mean age of onset 29 years). In the Register cohort, there were 1,608 (9.4%) with LOMS. When compared with AOMS, there was a lower proportion of women, a higher proportion of primary progressive MS, a higher level of disability at diagnosis (median MS impact scale 36.7 vs. 28.3, p < 0.001), and a higher proportion of gait-related initial symptoms. People with LOMS were less likely to receive a high efficacy disease-modifying treatment and attained substantial disability sooner. Controlling for age of death and sex, neuron density in the thalamus and pons decreased with onset-age, whereas actively demyelinating lesions and compartmentalized inflammation was greatest in AOMS. Only neuron density, and not demyelination or the extent of compartmentalized inflammation, correlated with disability outcomes in older-onset MS patients. The more progressive nature of older-onset MS is associated with significant neurodegeneration, but infrequent inflammatory demyelination. These findings have implications for the assessment and treatment of MS in older people. ANN NEUROL 2024;95:471-486.

Unlocking the potential of dimethyl fumarate: enhancing oncolytic HSV-1 efficacy for wider cancer applications.

Immunotherapy and specifically oncolytic virotherapy has emerged as a promising option for cancer patients, with oncolytic herpes simplex virus-1 (oHSV-1) expressing granulocyte macrophage colony stimulating factor being the first OV to be approved by the FDA for treatment of melanoma. However, not all cancers are sensitive and responsive to oncolytic viruses (OVs). Our group has demonstrated that fumaric and maleic acid esters (FMAEs) are very effective in sensitizing cancer cells to OV infection. Of note, these FMAEs include dimethyl fumarate (DMF, also known as Tecfidera®), an approved treatment for multiple sclerosis and psoriasis. This study aimed to assess the efficacy of DMF in combination with oncolytic HSV-1 in preclinical cancer models. We demonstrate herewith that pre-treatment with DMF or other FMAEs leads to a significant increase in viral growth of oHSV-1 in several cancer cell lines, including melanoma, while decreasing cell viability. Additionally, DMF was able to enhance ex vivo oHSV-1 infection of mouse-derived tumor cores as well as human patient tumor samples but not normal tissue. We further reveal that the increased viral spread and oncolysis of the combination therapy occurs via inhibition of type I IFN production and response. Finally, we demonstrate that DMF in combination with oHSV-1 can improve therapeutic outcomes in aggressive syngeneic murine cancer models. In sum, this study demonstrates the synergistic potential of two approved therapies for clinical evaluation in cancer patients.

Discovery of a brain-permeable bromodomain and extra terminal domain (BET) inhibitor with selectivity for BD1 for the treatment of multiple sclerosis

Multiple sclerosis (MS) is a neuroinflammatory autoimmune disease and lacks effective therapeutic agents. Dysregulation of transcription mediated by bromodomain and extra-terminal domain (BET) proteins containing two different bromodomains (BD1 and BD2) is an important factor in multiple diseases, including MS. Herein, we identified a series of BD1-biased inhibitors, in which compound 16 showed nanomolar potency for BD1 (Kd = 230 nM) and a 60-fold selectivity for BRD4 BD1 over BD2. The co-crystal structure of BRD4 BD1 with 16 indicated that the hydrogen bond interaction of 16 with BD1-specific Asp145 is important for BD1 selectivity. 16 showed favorable brain distribution in mice and PK properties in rats. 16 was able to inhibit microglia activation and had significant therapeutic effects on EAE mice including improvement of spinal cord inflammatory conditions and demyelination protection. Overall, these results suggest that brain-permeable BD1 inhibitors have the potential to be further investigated as therapeutic agents for MS.

Potential of Nano-Engineered Stem Cells in the Treatment of Multiple Sclerosis: A Comprehensive Review.

Multiple sclerosis (MS) is a chronic and degrading autoimmune disorder mainly targeting the central nervous system, leading to progressive neurodegeneration, demyelination, and axonal damage. Current treatment options for MS are limited in efficacy, generally linked to adverse side effects, and do not offer a cure. Stem cell therapies have emerged as a promising therapeutic strategy for MS, potentially promoting remyelination, exerting immunomodulatory effects and protecting against neurodegeneration. Therefore, this review article focussed on the potential of nano-engineering in stem cells as a therapeutic approach for MS, focusing on the synergistic effects of combining stem cell biology with nanotechnology to stimulate the proliferation of oligodendrocytes (OLs) from neural stem cells and OL precursor cells, by manipulating neural signalling pathways-PDGF, BMP, Wnt, Notch and their essential genes such as Sox, bHLH, Nkx. Here we discuss the pathophysiology of MS, the use of various types of stem cells in MS treatment and their mechanisms of action. In the context of nanotechnology, we present an overview of its applications in the medical and research field and discuss different methods and materials used to nano-engineer stem cells, including surface modification, biomaterials and scaffolds, and nanoparticle-based delivery systems. We further elaborate on nano-engineered stem cell techniques, such as nano script, nano-exosome hybrid, nano-topography and their potentials in MS. The article also highlights enhanced homing, engraftment, and survival of nano-engineered stem cells, targeted and controlled release of therapeutic agents, and immunomodulatory and tissue repair effects with their challenges and limitations. This visual illustration depicts the process of utilizing nano-engineering in stem cells and exosomes for the purpose of delivering more accurate and improved treatments for Multiple Sclerosis (MS). This approach targets specifically the creation of oligodendrocytes, the breakdown of which is the primary pathological factor in MS.

Russian-Belarusian Expert Council “New opportunities in the treatment of patients with multiple sclerosis” (October 1, 2023). Main conclusions of the first meeting

A joint conclusion of the Russian-Belarusian Expert Council “New opportunities in the treatment of patients with multiple sclerosis” on the organization of medical care, diagnosis and treatment of multiple sclerosis (MS) and other autoimmune diseases is presented. 12 neurologists from different medical institutions in Russia and Belarus took part in the work of the Council. In the conclusions of the Council, special attention was paid to two new Russian original drugs, modifying the course of MS. The place of these drugs in the healthcare system of these countries was determined. Sampeginterferon beta-1a itself is an effective and safe drug of first choice (first-line treatment) for relapsing remitting MS. Divozilimab is a highly effective and safe second-line treatment indicated for rapidly progressive and highly active MS, even when substituted for a firstor second-line treatment in relapsing remitting and secondary progressive (with exacerbations) MS. The experts emphasized how promising the use of these drugs is in the complex treatment of MS.

Ofatumumab – the first fully human monoclonal antibody approved for the treatment of multiple sclerosis

Currently, more than 15 molecules are already approved for the treatment of multiple sclerosis, and sometimes physicians encounter problems selecting a drug for therapy when considering patients with the initial equivalent characteristics. When selecting a drug, it is important to consider not only the efficacy and safety of the drug, but also the possibility of further therapy after discontinuation of the initially selected drug. This paper discusses the results of clinical trials on the efficacy and safety of ofatumumab and its potential advantages over other anti-CD20 agents.

Tonabersat Significantly Reduces Disease Progression in an Experimental Mouse Model of Multiple Sclerosis.

Multiple sclerosis (MS) is a neurodegenerative disease marked by chronic neuroinflammation thought to be mediated by the inflammasome pathway. Connexin 43 (Cx43) hemichannels contribute to the activation of the inflammasome through the release of adenosine triphosphate (ATP) inflammasome activation signals. The objective of the study was to evaluate if the Cx43 hemichannel blocker, tonabersat, is effective in modulating the inflammatory response and reducing disability in the myelin oligodendrocyte glycoprotein 35-55-induced experimental autoimmune encephalomyelitis (MOG35-55 EAE) model of MS. Here, we show that the Cx43 hemichannel blocking drug, tonabersat, significantly reduced expression of neuroinflammatory markers for microglial activation (ionized calcium-binding adapter molecule 1 (Iba1)) and astrogliosis (glial fibrillary acidic protein (GFAP)) while preserving myelin basic protein (MBP) expression levels in the corpus callosum, motor cortex, and striatum regions of the brain in MOG35-55 EAE mice. Reduced NOD-like receptor protein 3 (NLRP3) inflammasome complex assembly and Caspase-1 activation confirmed the drug's mode of action. MOG35-55 EAE mice showed clinical signs of MS, but MOG35-55 EAE mice treated with tonabersat retained behavior closer to normal. These data suggest that clinical trial phase IIb-ready tonabersat may merit further investigation as a promising candidate for MS treatment.

Algorithm for physical rehabilitation of patients with multiple sclerosis: practical experience

BACKGROUND: Multiple sclerosis is a pressing problem of modern society and healtcare. The high risk of disability of the able-bodied population, together with the observed trend of increase in morbidity and decrease in the age of onset of the disease, create a number of economic and social difficulties. It is well known that current medical treatment of multiple sclerosis is most effective in reducing the frequency of exacerbations and disability progression, but does not affect the already established residual manifestations, indicators of disability progression objectified by magnetic resonance imaging data.&#x0D; AIM: Evaluation of the effectiveness of using the algorithm for choosing a method of physical rehabilitation, according to the selected models of patients with multiple sclerosis.&#x0D; MATERIALS AND METHODS: The medical histories of patients aged from 31 to 58.8 (average age 48.9±8.6) years who were in hospital treatment were analyzed (n=504; men — 34%, women — 66%), of which 56% had no disability, 11% had disability group I, 25% had disability group II, and 8% had disability group III.&#x0D; RESULTS: An algorithm for working with patients in this category was developed from the perspective of functioning in the categories of the International Classification of Functioning, Disability and Health, and Assessment of Impairments, which is a huge part of the medical rehabilitation protocol for patients with multiple sclerosis.&#x0D; CONCLUSION: The proposed models of patients, including pronounced disorders, make it possible to systematize and standardize the process of rehabilitation measures, improve the quality of provided medical services and provide the population with qualified rehabilitation care.

Small-molecule targeting AMPA-mediated excitotoxicity has therapeutic effects in mouse models for multiple sclerosis.

While most research and treatments for multiple sclerosis (MS) focus on autoimmune reactions causing demyelination, it is possible that neurodegeneration precedes the autoimmune response. Hence, glutamate receptor antagonists preventing excitotoxicity showed promise in MS animal models, though blocking glutamate signaling prevents critical neuronal functions. This study reports the discovery of a small molecule that prevents AMPA-mediated excitotoxicity by targeting an allosteric binding site. A machine learning approach was used to screen for small molecules targeting the AMPA receptor GluA2 subunit. The lead candidate has potent effects in restoring neurological function and myelination while reducing the immune response in experimental autoimmune encephalitis and cuprizone MS mouse models without affecting basal neurotransmission or learning and memory. These findings facilitate development of a treatment for MS with a different mechanism of action than current immune modulatory drugs and avoids important off-target effects of glutamate receptor antagonists. This class of MS therapeutics could be useful as an alternative or complementary treatment to existing therapies.

A novel stability indicating mass compatible reversed‐phase high‐performance liquid chromatography for the determination of Diroximel fumarate and its related impurities

AbstractDiroximel fumarate (DRF) is a novel oral fumarate used in the treatment of multiple sclerosis. Comprehending DRF's stability behavior in different degradation conditions is crucial and has been studied under photolysis, oxidative, hydrolysis, and thermal conditions. Nucleosil C18 column (250 × 4.6 mm, 5 μm) was employed to achieve drug separation, with a mobile phase comprising of water and acetonitrile (65:35, v/v). The flow rate was 1 mL/min and detection was performed at 210 nm using a photodiode array detector. The fully validated reversed phase‐high‐performance liquid chromatography stability method as per the International Council for Harmonization Q2 R1 demonstrated excellent selectivity, accuracy, and precision with good sensitivity. During the analysis, two prominent degradant product peaks of DRF were identified across all stress conditions. The usage of liquid chromatography‐mass spectrometry compatible solvents in the mobile phase permits further characterization of DRF and its degradants peak. Significant levels of degradation were found in alkaline and acidic hydroxide, peroxide, photolytic, and thermal conditions with hydrolysis being postulated as a possible mechanism of degradation. The fully validated stability‐indicating analytical method can be used for routine quality control and stability testing of DRF, requiring storage in a protected primary container, as it is sensitive to light and moisture.

The effect of a mobile education application (MobilMS) developed for multiple sclerosis patients in Turkey on symptom management and quality of life: A randomized controlled study

BackgroundMultiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system (CNS) and is caused by immune dysfunction. MS results in a variety of symptoms that affect physical, emotional, social, and cognitive functioning. Effective symptom management is a critical factor in improving the quality of life (QoL) of patients with MS. PurposeTo determine the effects of a comprehensive mobile education application developed for Turkish patients with MS on symptom management and QoL. MethodsThe study was conducted as a randomized controlled trial and included 63 patients with MS older than 18 years who had an Expanded Disability Status Scale score of ≤6 and were actively using smart phones (intervention group, n = 31; control group, n = 32). Data were collected using a patient information form, the Multiple Sclerosis-Related Symptom (MS-RS) checklist, the Multiple Sclerosis Quality of Life Scale (MSQoL-54), and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ). The scales were administered three times: at baseline, first month, and third month. Patients with MS in the intervention group were followed up for three months using MobilMS. ResultsIn the intervention group, the mean rating of MobilMS was 8.74±1.29. Most patients indicated that MobilMS was an “informative and useful application”. None of the patients in the study reported any side effects or difficulties when using MobilMS application. The mean MSQL-54 score of the intervention group was significantly higher compared to that of the control group at the first and third months (p = 0.001). The mean scores on the MS-RS checklist (p = 0.985), MS-TAQ subscale, Disease modifying therapies (DMT) barriers (p = 0.237), DMT side effects (p = 0.994), DMT coping strategies (p = 0.469), and Missing Doze Rate (MDR) (p = 0.765) were lower in the intervention group than in the control group, but these results were not statistically significant. ConclusionThe results of the study showed that MobilMS was highly appreciated, accepted, and used by patients with MS. MobilMS has the potential to meet the requirements for a free and accessible symptom management tool for patients with MS. The innovative MobilMS-based education intervention for support and symptom management is recommended as part of supportive care for this patient population. It is hoped that this study will pave the way for future studies on the utility of mobile applications for symptom management in patients with MS.