Multiple Sclerosis Treatment Algorithms

AUGUST 25, 2015
MD Magazine Staff

The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.
This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.
The panelists are:
  • Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
  • Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
  • Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School
A treatment algorithm for MS does not exist, said Lublin. Choosing a treatment take a detailed conversation with the patient about “efficacy, safety, side effects, convenience, and – and this is in order of importance – lastly the hassle factor of actually getting them the drug which we all have to put up with.” The patient’s preferences in terms of mode of administration and how long the treatment has been available should also be discussed. “We as a community have two important things to determine. One is who needs really aggressive therapy up front. And the second is when someone’s failing,” said Lublin.
“I like to group the DMTs into three options, first the first-line parenterals – that interferon betas, glatiramer acetate, that have been around for years – secondly the three orals that are much newer, and thirdly the ‘second line.’ I don’t know that I like that so much, but the higher risk drugs, intravenous drugs that may have great potency, efficacy, but have higher risk,” said Coyle. Furthermore, she advised following a strategy similar to the American College of Rheumatology’s rheumatoid arthritis treatment plan, looking at extent of disease and prognostic profile. “And certainly if somebody has very active disease with a poor prognostic profile, efficacy suddenly becomes way more important in my counseling and recommendations to that patient.” Dhib-Jalbut agreed that lesion burden would be taken seriously, causing him to treat more aggressively, especially if the patient is young.

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