Too few patients considered candidates for treatment optimization


REPORT FROM ECTRIMS – BARCELONA, SPAIN – OCTOBER 7-10, 2015 – In 2007-2008, a retrospective analysis of over 9,000 patient records in Germany reported that about one-third of treated MS patients experienced one or more relapses in the preceding year and about 24% were candidates for treatment escalation according to clinical and radiological criteria (Maurer et al. Eur J Neurol 2011;18:1036-1045).

Since that time, the number of options for treatment optimization has expanded considerably, so a second study was performed in the period 2010-2014 (Schmidt et al. ECTRIMS 2015; abstract P294).

Data were analysed for MS patients on treatment for at least 24 months. Mean age was 44.8 years; mean MS duration was 9.6 years; and median EDSS score was 2.0. Data were complete for 1,594 patients. Overall, 810 (50.8%) had evidence of ongoing disease activity, defined as >1 relapse or EDSS progression (>0.5 points) or increased MRI activity in the preceding 24 months. Neurologists rated their patients as improved in 2.3%, stable in 64.8%, or worsened in 31.9%. As a result, a switch to another disease-modifying therapy was considered in only 24.7% of patients.

Thus, while a majority of patients have ongoing disease activity, clinicians are likely to view patients as clinically stable. As a result, treatment optimization is generally not considered to be necessary in practice. The authors concluded that ongoing disease activity needs to be systematically documented to optimize treatment decision-making in practice.

Reviewer: Dr. Daniel Selchen, Head of Neurology, St. Michael’s Hospital, Toronto, Canada

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