Sequencing disease-modifying therapies: what is the rational approach?

MS Sequencing: Part 8 – MS therapies in practice: Reader survey results


Comment by Dr. Daniel Selchen

Over the past year, NeuroSens has explored some of the clinical considerations when sequencing therapies in patients with relapsing-remitting MS. The series reviewed the mechanisms of action of disease-modifying therapies in targeting T and B lymphocytes (Part 1), initiating treatment (Part 2), evaluating treatment response (Part 3), treatment planning throughout the disease course (Part 4), lateral switching versus escalation (Part 5), safety considerations (Part 6), and general principles when sequencing therapies (Part 7). The series attracted over 1,000 page-views (as such things are measured online), Read More

MS Sequencing Part 7: What is a rational approach?


Comment by Dr. Paul Giacomini
NeuroSens survey on sequencing – Part 7

A towering edifice of MS therapies has been built in recent years, but the structure has an exceedingly narrow base of evidence when it comes to how to sequence these agents. How does one construct something that won’t come crashing down – either because of too little efficacy or efficacy deferred, or too great a risk for the benefits that can be achieved? And in devising a blueprint, how does one manage the risk conundrum: younger, less disabled patients generally wish to avoid risk when a more aggressive approach may well change the slope of progression; whereas older, more disabled patients are ready to assume greater risks, when it is likely too late to change the outcome? Read More

MS Sequencing: Part 5 – Strategies for optimizing response


Comment by Dr. Jiwon Oh
NeuroSens survey on sequencing – Part 5

Most RRMS patients begin their treatment journey with a platform therapy, either an injectable or a first-line oral (teriflunomide or dimethyl fumarate in Canada) (see Part 2 of this series). Many will remain on the platform long after the train has pulled out. Only a minority will have their DMT regimen optimized, even when it is recognized that the current treatment has failed (see Part 4 of this series). Read More