Talking to Patients about Their Multiple Sclerosis
AUGUST 30, 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
To help patients and families understand, Dhib-Jalbut gives out two sets of material comparing aspects of different treatments after settling on one or two treatment options. The treatment decision is then made after they have had a chance to digest the material.
There is no clear definition of treatment failure, said Lublin, and “the only way to know of course is to switch and go to other things.” It is hard to determine if it is treatment failure or simply disease progression. Coyle said that she would consider switching treatments in that case. “I do believe there’s a window of opportunity to get an optimum response to a disease-modifying therapy,” she said, but “There are different ways to fail.” These ways can include intolerability, noncompliance, or unacceptable breakthrough activity.
In the absence of absolute treatment guidelines, Coyle said, “I think we can start to say treat early, use the prognostic profile and disease activity, follow them closely. If there’s unacceptable activity, make a switch. I mean, these are central principles I think everybody could endorse right now for MS.”