Trend to earlier, more aggressive therapy: U.S. survey


REPORT FROM THE ACTRIMS-ECTRIMS – BOSTON, MA, SEPTEMBER 10-13, 2014 – A U.S. survey of academic and community neurologists from the Consortium of Multiple Sclerosis Centers (CMSC) reports that clinicians tend to favour an earlier, more aggressive treatment approach (Tornatore et al. ECTRIMS 2014; abstract P295).

Surveys were completed by 107 neurologists in the period December 2013-April 2014. A total of 73% would treat RRMS if it was clinically silent but there was an active MRI scan. In clinically stable RRMS on treatment, a majority of neurologists stated that they would switch therapies if the patient had one new Gd-enhancing lesion, or 2-4 T2 lesions. Clinicians also agreed on continuing treatment in RRMS patients who were clinically and radiologically stable for five years.

One indication of a more aggressive approach: 70% said they would treat radiologically isolated syndrome (RIS) if one gadolinium-enhancing lesion were observed. In addition, 73% would treat clinically silent RRMS based on MRI findings alone.

There was a general consensus on when to initiate treatment, but not on the optimal starting therapies. There was also no consensus on the best way to switch from one treatment to another, nor on the optimal duration of the washout period. However, respondents did agree that no washout period was needed when switching from one injectable to another.

Almost 100% of respondents recommended a follow-up MRI within 1 year of presentation, whether or not a treatment was initiated.

Guest Reviewer: Dr. Daniel Selchen, St. Michael’s Hospital, Toronto, Ontario.

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