Sequencing MS therapies – a changing landscape


Comment by Dr. Virender Bhan – Senior neurologist, Burnaby/Vancouver, BC, Canada.

NeuroSens recently posted a survey on sequencing disease-modifying therapies (DMTs) in multiple sclerosis to investigate whether clinicians’ approaches have changed in the past 2-3 years. The current survey was a follow-up to a series of surveys conducted over a one-year period ending in December 2017 that accompanied an 8-part article on sequencing. (For a summary of those results see Are opinions changing on changing therapies in MS?, NeuroSens, October 22, 2019). Read More


Are opinions changing on changing therapies in MS?


Click here to take the new sequencing survey
Cliquez ici pour remplir le nouveau sondage sur les séquences thérapeutiques

Two years ago, NeuroSens concluded its eight-part series on sequencing disease-modifying therapies (DMT) in multiple sclerosis. Expert commentaries were provided by Canadian MS specialists, including Drs. Mark Freedman, Ottawa; Michael Yeung, Calgary; Paul Giacomini, Montreal; Daniel Selchen, Toronto; Jiwon Oh, Toronto; and Marc Girard, Montreal. Each article was accompanied by a reader survey to identify clinicians’ goals of therapy, DMT use and perceptions about the relative benefits and risks of different treatment sequences. Read More

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