Evidence-based medicine calls for ongoing research and refinement of best practices for treating various diseases. In this spirit, a multi-disciplinary panel recently convened to develop recommendations for disease-modifying therapy for those with multiple sclerosis.
This panel certainly was busy, in all they developed 30 recommendations; 17 of which related to when/how to start on disease-modifying therapy (DMT), 10 related to switching DMTs in cases of disease progression, and the final 3 were about stopping DMTs. The panel presented these guidelines at the 2018 American Academy of Neurology Annual Meeting and then published them in Neurology.
First things first: disease-modifying therapies are a key part of MS treatment and are the best current strategy to slow the course of this disease. There are now approximately 17 medications in this category and they include medications that are injected (e.g., Copaxone and Zinbryta), infused (e.g., Lemtrada and Ocrevus), and taken orally (e.g., Gilenya and Tecfidera). None of these can cure MS but they do each have a proven record of effectiveness in controlling the disease. However, a medication that currently works for a patient may not work in the future, which is why medications sometimes need to be changed.
The following are some are the highlights about DMT use from this panel’s recommendations:
The earlier treatment for MS starts, the better the chances are for altering the disease course. Starting treatment sooner generally means fewer relapses and lessens the injuries to the brain.
Newly diagnosed patients do better when they hear their treatment options at a dedicated treatment visit. This is because patients can have trouble processing the large amount of new information at a diagnosis appointment.
It’s important to take patient preference into account regarding the different options of medications (cost, route of administration, safety, and so on).
Health care providers should take care to counsel patients about realistic expectations of what DMTs can achieve in treatment.
It’s important to continue monitoring patients on DMTs in terms of adherence, side effects, and safety.
Reproductive plans are an important part of the discussion with patients (e.g., male infertility and risks of DMT use in pregnancy).
Monitoring of disease activity (in terms of new lesions and relapses) can inform the decision to change DMTs. If a medication switch is warranted, consider changing to a medication with a different mechanism or efficacy profile as well as to a medication that is taken through a different route (injection vs. infusion vs oral).
If a patient discontinues taking DMT medications, counseling about the likelihood of relapse is important.
Cost can be a huge barrier to patients when accessing treatment. Providers should also guide patients in need to financial assistance sources.
Overcoming financial challenges is one of the ways BioPlus Specialty Pharmacy supports our patients, including those on medications for multiple sclerosis. Our patient financial assistance department works to ensure that financial barriers are overcome so patient treatment can both start and continue.
Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline: disease-modifying therapies for adults with multiple sclerosis. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Presented at: 2018 American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles, CA.
Ciccone A. Multiple sclerosis guidelines: AAN’s recommendations for initiating, switching, stopping disease-modifying therapy. Neurol Adv April 23, 2018.