"I would appreciate your comments on the following beta version of a treatment or monitoring algorithm for relapsing MSers. The idea is to adopt the strategy of treating-2-target; the target being NEDA or no evidence of disease activity. This approach has being adopted from the rheumatologists who developed this strategy about 15 years ago to treat rheumatoid arthritis (RA). In general, rheumatologists treat RA very early, and very aggressively, and escalate treatment rapidly to the more active biological therapies if there is no response to 1st-line treatments. Their aim is to prevent joint damage occurring from ongoing inflammation. This approach has worked for RA very well; there has been a major drop-off in RAers needing joint replacements. The difference between MS and RA is that we don't have the option of replacing the brain and spinal cord; there is no fall back option for MSers."
"The aim of the algorithm is for neurologists to do the same for relapsing MSers as rheumatologists do for RAers. If we adopt this active/aggressive approach will MSers do better when compared to MSers managed more conservatively or less actively, for example allowed to have disease activity on 1st-line therapies or have a significant delay when starting treatment? We won't know unless we try! The problem is getting the MS community to move in this direction and to make sure we all monitor the MSers in our care or at least provide them with the tools to monitor themselves."
"Neurologists are generally quite a conservative bunch, whereas rheumatologists have always been more aggressive. I think this relates to rheumatologists having had DMTs for several generations. May be the field is ready for a change?"
Labels: disease-activity free, NEDA, treat-2-target