Tuesday, 19 August 2014

ClinicSpeak: Are we ready for a consensus statement regarding DMTs?

Do you buy into consensus statements or not? Can it work for MS DMTs? #ClinicSpeak #MSBlog #MSResearch

"Almost every week I am asked when are we neurologists going to come out with consensus guidelines on how to treat MS? Pharma are particularly interested in us defining specific algorithms so that their drug, or drugs, get prescribed appropriately and more frequently. I still maintain that a strict algorithm is bound to fail as there are so many variables to consider when prescribing DMTs for any particular individual. In addition, organisations such as NICE are so behind the adoption curve that any consensus based on their recommendations are bound to be incongruent with International practice. It is therefore reassuring that the the National MS Society (NMSS) and the other member organizations of the MS Coalition have collaborated to produce a consensus document to summarise current evidence about DMTs; albeit for the US."


"The following is a summary of the treatment considerations that are all supported by a well-established evidence-base. What is important to note that the treatment considerations are broad principles and leave it up to the neurologist and MSer to decide on the exact course of action. Most consensus statements have a very short half-life; I wonder how long these will last! Despite my cynicism, I must congratulate all the participants for producing such a well-written and considered document."

The following are the headline treatment considerations:
  1. Initiation of treatment with an FDA-approved disease-modifying treatment is recommended
    • As soon as possible following a diagnosis of relapsing MS
    • For individuals with a first clinical event and MRI features consistent with MS, in whom other possible causes have been excluded
    • For individuals with secondary-progressive multiple sclerosis who continue to demonstrate clinical relapses and/or demonstrate inflammatory changes on MRI
  2. Treatment with any given disease-modifying medication should be continued indefinitely unless any of the following occur: 
    • Sub-optimal treatment response as determined by the individual and his or her treating clinician
    • Intolerable side effects
    • Inadequate adherence to the treatment regimen
    • Availability of a more appropriate treatment
  3. Movement from one disease-modifying treatment to another should occur only for medically appropriate reasons.
  4. When evidence of additional clinical or MRI activity while on treatment suggests suboptimal response, an alternative regimen (e.g., different mechanism of action) should be considered to optimize therapeutic benefit.
  5. The factors affecting choice of treatment at any point in the disease course are complex and most appropriately analyzed and addressed collaboratively by the individual and his or her treating clinician.


CoI: multiple

4 comments:

  1. Consenus from neuros....easier to herd cats:-)

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  2. This is a fudge and is only really a consensus on the underlying principles of treatment. I wonder what neurologists in the UK and the ABN will have to say about them? I note they are implying MSers are monitored with MRI. Prof. G any comments on the latter?

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  3. From number 1 part three, have any DMT been approved by the FDA for treatment of progressive MS?

    On number 3, I wonder if cost or convenience count as enough to meet "more appropriate" standard.

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  4. Great resource, especially the comparison tables - thank you!
    J

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