The Multiple Sclerosis Coalition’s consensus paper on the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) includes the following recommendations:
• Treatment with an FDA-approved DMT should be initiated as soon as possible following a diagnosis of relapsing disease; after a first clinical event with MRI features consistent with MS in which other causes have been ruled out; and in patients with progressive MS with clinical relapses and/or inflammatory activity.
• Treatment with DMTs should continue indefinitely unless there are intolerable side effects, inadequate adherence, sub-optimal treatment response, or a more appropriate option becomes available.
• When additional clinical or MRI activity occurs while on treatment, consider an alternate regimen with a different mechanism of action.
• Absence of relapse while on DMT should not be considered a reason to discontinue treatment.
The full report is available here.
Citation: Costello K, Halper J, Kalb R, Skutnik L, Rapp R. The use of disease-modifying therapies in multiple sclerosis: principles and current evidence. A consensus paper by the Multiple Sclerosis Coalition. http://www.nationalmssociety.org/getmedia/5ca284d3-fc7c-4ba5-b005-ab537d495c3c/DMT_Consensus_MS_Coalition_color. Updated March 2015. Accessed April 30, 2015.
Commentary: Multiple Sclerosis is a disease with no cure but treatment options that have evolved and expanded over the past 25 years. The need to treat early, treat effectively, and to monitor for disease activity not apparent clinically but identified on MRI and by other metrics has become more critical due to the multiplicity of treatment options. The complexity and nuances of mechanism of action, route, frequency, efficacy, sequencing, and monitoring for disease modifying therapy has also become more involved, and keeping abreast of the ever expanding and important information required to effectively treat this illness has become more than a full time job.
This article is an extremely important review of many of the ins and outs, risks and benefits, and options of treatment. More importantly, it is a comprehensive resource with background information regarding the impact of this disease related to cognition, fatigue, mood, and incidence of these less commonly recognized but ever-present burdens that add to disease-related disability that should be identified and treated along with disease activity. To provide anything less than effective and comprehensive care is no longer justified. This review provides an overview of care needs and treatment options for MS clinicians and for our patients. — Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY