ClinicSpeak: CME for HCPs and treatment algorithms

Sequencing of DMTs is a real challenge. Are we ready to adopt algorithms? #ClinicSpeak #MSBlog #MSResearch

"I spoke at an MS CME (continuing medical education) event in Frankfurt yesterday. I have uploaded the programme and my talk for you to see and download. At the meeting I had to give consent for my slides to be uploaded on the meeting's portal and guess what? The meeting portal is only open to HCPs (healthcare professionals). In other words you can only access the content of you happen to be an MSer who works in the field (medical doctor, nurse, physio, etc.) and has attended the meeting. When we last debated this issue a few weeks ago I ran a short survey and the results speak for themselves."

"As you can see from the title of my talk the field is moving towards treatment algorithms and what to do when a platform or intermediate efficacy drug fails you. You won't be surprised to note many of my old slides in this talk; repetition is the name of my game. Please note I am advocate of choice, but there is little denying of the facts; if you go onto a high efficacy drug from the outset you will on average do better. Similarly, if you escalate to a high-efficacy drug sooner you will on average do better than moving sideways from one platform drug to another platform drug."

"Please note in terms of second or third line use that Teriflunomide (Slide 32) does remarkably well compared to DMF (dimethyl fumarate, Slide 31). DMF is more efficacious in MSers naive to other DMTs (Slide 31) compared to when it is used 2nd or 3rd line. Based on this I think DMF is much better as a first-line drug, whereas Teriflunomide may have a role to play second line, particularly if the MSer concerned is risk adverse."

"I had a lot of questions about my bridging strategy post-natalizumab (Slide 34). Please note that at present there is only data to  support fingolimod as a bridging agent. The emerging data indicates that DMF is not effective enough as a DMT to prevent rebound and we don't have data on Teriflunomide. There is a trial running in the US at present assessing the latter. As teriflunomide is anti-proliferative it may prevent the proliferation of T-cells that drive MS rebound on natalizumab withdrawal; let's hope we get the data sooner than later."

CoI: multiple

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