Comment by Dr. Marc Girard
NeuroSens survey on sequencing – Part 6

When switching from one disease-modifying therapy (DMT) to another in patients with RRMS, consideration must be paid to the potential short- and long-term consequences of administering drugs in sequence. Read More

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

Comment by Dr. Daniel Selchen
NeuroSens survey on sequencing – Part 4

The doubling of therapeutic options over the past decade for the management of relapsing-remitting multiple sclerosis (RRMS) has made treatment decision-making considerably more complex. Most patients will require or request a change in medication over the first few years of treatment, so it is important to have a plan from the outset that will optimize outcomes and minimize risk. A good plan today, as General Patton is quoted as saying, is better than a perfect plan tomorrow, not least because of the innumerable unknowns about MS and its treatment.
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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.

The expectation is that many patients may respond adequately to a first-choice agent, and those with “breakthrough” disease activity can be switched at a later visit. So risk can be titrated up according to the clinical need. Read More

Comment by Dr. Michael Yeung
NeuroSens survey on sequencing – Part 2

Clinicians managing a newly-diagnosed patient with relapsing multiple sclerosis are faced with a welter of treatment options. In the past few years in Canada, platform therapies have expanded from the injectable BRACE to an injectable/oral CABARET: Copaxone, Avonex, Betaseron, Aubagio, Rebif, Extavia and Tecfidera.

In addition, there are new formulations of Copaxone (administered three times/week) and Avonex (Plegridy, administered subcutaneously q14 days). (Additional first-line options exist in other countries.) Read More