#191: BTK inhibitors in MS: where do we stand after ECTRIMS/ACTRIMS 2026?

BTK inhibitors have produced different results in multiple sclerosis trials. In episode no. 191, I explore what we learned at ECTRIMS/ACTRIMS 2026 about individual medicines, their potential benefits and their safety.

Drawing on presentations by Amit Bar-Or, Laura Airas and Stephen Krieger, I explain why the medicine, study population and outcome measures all matter. This is a solo research recap, rather than an interview with the speakers.

Read the accompanying blog post:
https://ms-perspektive.de/en/191-btki-ectrims-actrims-2026/

Topics covered

• How BTK inhibitors act on immune cells and why the medicines differ

• Results for evobrutinib, tolebrutinib, fenebrutinib and remibrutinib

• Relapse control and disability progression across different MS populations

• Why headline percentages cannot be compared directly

• Biomarkers, participant selection and meaningful trial outcomes

• Liver safety and other concerns requiring careful assessment

• Different European and US regulatory decisions on tolebrutinib

• BTK inhibitors as a possible future maintenance strategy

Chapters

00:00 Welcome to MS-Perspektive
00:39 BTK inhibitors after ECTRIMS/ACTRIMS 2026
02:07 Why BTK inhibitors matter
03:27 How the medicines differ
04:34 Evobrutinib: disappointing phase 3 results
05:33 Tolebrutinib: different outcomes across MS populations
07:26 Fenebrutinib: relapse results and the PPMS comparison
09:24 Remibrutinib: newer trial findings
10:54 Why trial results cannot be ranked directly
11:52 Selecting trial participants by biology
13:07 Measuring meaningful outcomes
14:02 Safety risks vary by medicine
15:04 Different European and US regulatory decisions
16:21 Could BTK inhibitors become maintenance treatments?
17:13 What the evidence means for people with MS
18:25 Closing thoughts and the next episode

Research and further reading

Evobrutinib: evolutionRMS 1 and 2 trial results

Tolebrutinib in relapsing MS: GEMINI 1 and 2

Tolebrutinib in non-relapsing secondary progressive MS: HERCULES

Fenebrutinib: Roche's trial and regulatory update

Remibrutinib: Novartis's REMODEL results update

European Medicines Agency: Cenrifki / tolebrutinib

FDA complete response letter for tolebrutinib

Trial and regulatory information reflects the research reviewed for this episode on 9 November 2026. Company updates are identified by source.

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See you soon and try to make the best out of your life,
Nele

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