MS Guidelines Released for Disease-Modifying Therapies

10/31/17

The first guidelines on the use of disease-modifying therapies in multiple sclerosis (MS) have been issued by the European Committee for Research and Treatment of Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN).

The guidelines were presented at the 7th Annual Joint ECTRIMS-Americas Committee for Research and Treatment of Multiple Sclerosis (ACTRIMS) 2017 meeting (October 25-28, 2017; Paris, France) by Xavier Montalban, MD, director of the Multiple Sclerosis Centre (Catalonia, Spain).

Among the notable guideline recommendations are:

The American Academy of Neurology are also in the process of developing guidelines on the use of disease-modifying drugs in MS.—Zachary Bessette

  • Offer interferon or glatiramer acetate to patients with CIS and abnormal MRI findings with lesions suggesting MS who do not fulfill full criteria for MS.

  • Offer early treatment with disease-modifying drugs in patients with active relapsing-remitting MS, as defined by clinical relapses and/or MRI activity.

  • Consider treatment with mitoxantrone in patients with active secondary progressive MS, taking into account the efficacy and specifically the safety and tolerability profile of this agent.

  • Consider ocrelizumab for patients with primary progressive MS.

  • When monitoring treatment response in patients treated with disease-modifying drugs, perform standardized reference brain MRI within 6 months of treatment onset and compare the results with those of further brain MRI. Adjust the timing of both MRIs, taking into account the drug's mechanism and speed of action and disease activity, including clinical and MRI measures.

  • When monitoring treatment response in patients treated with disease-modifying drugs, the measurement of new or unequivocally enlarging T2 lesions is the preferred MRI method, supplemented by gadolinium-enhancing lesions for monitoring treatment response.
     
  • When monitoring treatment response in patients treated with disease-modifying drugs, the measurement of new or unequivocally enlarging T2 lesions is the preferred MRI method, supplemented by gadolinium-enhancing lesions for monitoring treatment response.
     
  • When monitoring treatment safety in patients treated with disease-modifying drugs, perform standard reference MRI every year in patients at low risk for progressive multifocal leukoencephalopathy (PML), and more frequently in patients at high risk for PML and in patients at high risk for PML who switch drugs at the time the current treatment is discontinued and the new treatment is started.

The American Academy of Neurology are also in the process of developing guidelines on the use of disease-modifying drugs in MS.—Zachary Bessette