Clinic Speak: treat-2-target of NEDA vs. current practice

What you think of a trial to test treat-2-target of NEDA? #MSBlog #MSResearch #ClinicSpeak

“As you know neurologists in the UK are handcuffed by NICE and NHS England Guidelines on treating MS. These guidelines are very prescriptive and don’t allow switching or escalation of treatment using MRI. MSers have to fail on their therapy clinically, and sometimes badly, to access more effective therapies. MSers with smouldering MS are left to accrue end-organ damage on lower efficacy medication because we can’t escalate their treatment. To try and address this issue a group of MSologists and I are discussing doing a pragmatic clinical trial to see if MSers manage using a standard care pathway do worse than those managed more actively with a treat-2-target of no evident disease activity (NEDA). The latter algorithm allows one shot at a lower-tier efficacy drug before being escalated to a highly-efficacy therapy and incorporates MRI monitoring. The standard care pathway allows cycling on the lower tier and only escalation based on clinical criteria as per our current guidelines. The picture below sketches out the trial. Please note this has to be a randomised trial so that we can minimise any biases. Do you think this trial is ethical and would you be willing to participate in it? We are suggesting that it last 5 years.”

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