30-Second Takeaway
- NMOSD trials are rapidly expanding with biologics dominant but transparency gaps remain.
- One-quarter of late-stage MS drug trials fail, often from recruitment or business reasons.
- Candesartan and amitriptyline reduced moderate-severe migraine days in real-world practice.
Week ending May 2, 2026
Practical evidence brief: recent trials, feasibility, and real-world effectiveness across neuroimmunology, MS rehabilitation, and migraine prevention
Global NMOSD trials growing fast; biologics predominate and result reporting is incomplete.
A systematic overview identified 141 registered interventional NMOSD trials through August 2025, with phase I studies most common (35.8%). Therapeutic focus prioritized B-cell depletion (34.0%), complement C5 inhibition (17.6%), and IL-6 receptor blockade (10.9%). Nearly half of trials were completed but 31.9% lacked public results, and China (64.5%) and the United States (24.8%) led activity. Primary endpoints emphasized safety and relapse prevention; visual outcomes, patient-reported measures, and biomarkers were infrequently included.
One in four late-stage MS trials fail, often for recruitment or business reasons.
Among 282 phase III/IV MS drug trials (2008–2024), 25.2% failed while 74.8% ended normally. Top reported failure reasons were low recruitment (28.2%), business decisions (26.8%), and logistical problems (12.7%). Failed trials stopped earlier (mean 17.8 months) than completed trials (28.2 months). Trials assessing safety and those with ≥50 centres had lower failure odds, highlighting the protective effect of larger, safety-focused designs.
Module progression predicts processing-speed gains after RehaCom training in progressive MS.
Secondary analysis of 153 progressive MS participants found progression in specific RehaCom modules correlated with SDMT improvement. Baseline SDMT, premorbid IQ, age, and module progression jointly predicted 12-week SDMT performance (adjusted R2 = 0.73). At 6 months, baseline SDMT, progression in Attention/Concentration and Divided Attention-2, age, and female sex predicted outcomes (adjusted R2 = 0.71). Results support tailoring RehaCom module choice to individual cognitive profiles rather than relying on dose alone.
References
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Additional Reads
Optional additional studies from this edition.