MS Sequencing: Part 3 – Evaluating treatment response

 

Comment by Dr. Paul Giacomini
NeuroSens survey on sequencing – Part 3

Most RRMS patients starting treatment with a disease-modifying therapy (DMT) will necessarily begin with a front-line injectable (interferon-beta, glatiramer acetate) or oral therapy (teriflunomide, dimethyl fumarate; fingolimod in some countries). As previously noted (see Part 2 in this series), clinicians opt for a treatment with a favourable risk-benefit profile, which is generally defined as low-risk and low-benefit.

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* What criteria do you use in practice to identify patients with an inadequate response to their first line treatment?

* How often do you assess relapses in your RRMS patients?

* How often do you obtain an MRI in a newly-treated RRMS patient?

* How often do you obtain an MRI in a stable RRMS patient on treatment for greater than 5 years?

* How do you define “stable disease” in a patient on a first-line disease-modifying therapy (i.e. injectable, teriflunomide, DMF)?

* How do you define “stable disease” in a patient on a second-line disease-modifying therapy (i.e. fingolimod, natalizumab, alemtuzumab)?

* What proportion of your RRMS patients on treatment for greater than 2 years have stable disease?

* What proportion of your RRMS patients on treatment for 3-5 years have stable disease?

* What proportion of your RRMS patients on treatment for greater than 5 years have stable disease?

* What proportion of your RRMS patients with breakthrough disease on a first-line treatment will be switched to another DMT over the next 2-3 years?

* What proportion of your patients switched due to breakthrough disease will receive fingolimod?

* What proportion of your patients switched due to breakthrough disease will receive natalizumab?

* What proportion of your patients switched due to breakthrough disease will receive alemtuzumab?

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