Adaptive trials and new designs.

Neurological therapeutics are advancing rapidly, yet many neurodegenerative diseases still lack effective disease-modifying treatments, in part because traditional trial designs are ill-suited to slowly progressive, heterogeneous disorders. Adaptive methods and multi-arm approaches have improved early-phase efficiency but remain limited when used within isolated trials. Multi-arm multi-stage (MAMS) platform designs offer a more powerful solution by evaluating multiple interventions concurrently against a shared control, incorporating interim analyses to stop futile arms early, and enabling addition of new treatments and biomarkers over time within a single, continuous phase-3-capable infrastructure. Experience from oncology and infectious disease demonstrates the feasibility and impact of these platforms. Emerging neurological MAMS trials - such as MND-SMART, ACT-PD, AD-SMART and OCTOPUS in progressive multiple sclerosis - show that these designs can accelerate evaluation, reduce cost and participant burden, and remain responsive to scientific advances.