Doughnuts or Bagels

"The following is my presentation from a meeting last Friday. I gave this presentation to a group of colleagues from the UK; MSologists from the whole of the UK. We all agreed that the current guidelines for prescribing DMTs in the UK need to be modified to allow us more flexibility and to close the hole in the doughnut! I think the consensus was  that we should aim for the disease-activity free state, but at the moment that is not possible as the guidelines prevent escalation of treatment in all MSers failing 1st-line DMTs. The current prescribing guidelines only allow escalation if you fail DMTs with highly-active disease."

"The other issue I raised is that the prognostic tools we have at the moment are better than we realise. In addition, activity on 1st-line DMTs means something completely different to activity on no treatment at all. Having disease activity on 1st-line treatments is a poor prognostic sign and indicates that you are going to do badly in the future. This is unlike the natural history studies in which relapses, outside the first 2 years, are generally not predictive of future disability. We all agreed that the issues raised in the presentation need to be debated nationally. Hopefully we can arrange a meeting in the New Year to get all UK MSologists together to discuss this issue and to form a lobby to change things for MSers in the UK. At the moment we are letting you down."



MS Doughnut or Bagel ver. 2 from Gavin Giovannoni

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