PoliticalSpeak: quote of the week

Is there really an ongoing debate about the use of DMTs in early MS? Or is this debate limited to the UK? #MSBlog #PoliticalSpeak

Dr Paul Cooper, Salford Royal Foundation Trust

Excerpt from: Smitha Mundasad. Multiple sclerosis drugs should be offered earlier. BBC News 30 Sept. 2015


Quote(s) of the week: ".... although disease-modifying drugs have a role in established relapsing, remitting disease, there is still debate about their use early on in the condition......"

"..... these drugs are potent with potentially long-term side-effects and consequences, therefore we have to balance the risks and benefits....."

"....... NICE is looking into these issues but the analysis is not yet complete and the data needs to be looked at carefully......."

"..,.... there are other things that can help people with multiple sclerosis, including better accesses to specialists and physiotherapy......."


Dr Paul Cooper, English Neurologist who advises the National Institute of Health and Care Excellence (NICE).

"MouseDoctor took me and DrK to task over this quote. I think we need to put the quote into context and understand that the real issue is not whether, or not, early treatment is indicated, but whether the current costs of DMTs make this treatment policy cost-effective. In other words is it not more cost-effective at a societal level to let MSers wait a few years to see who develops more active disease before offering DMTs? This wait and see approach will expose less MSers to the risk of the DMTs, save the NHS resources, which could potentially be invested in other MS-related services, and identify MSers with 'benign disease' who may not need DMTs."

"The downside of the wait and see approach is the damage, which may be hidden, that is occurring in MSers who are not on treatment but simply waiting for their disease to re-manifest clinically. Please note that in the UK MRI monitoring of MS disease activity is rarely done therefore ongoing hidden damage will not be taken into account by this approach. In our policy document we try and address the cost-effectiveness issue and recommend exploring innovative ways of making DMTs accessible in a cost-effective way."

"As you know these issues are very close to my heart. On my sabbatical I was appalled at how few MSers in resource-poor countries were on DMTs. This prompted me to generate my essential off-label DMT list. The latter has caused problems for me; for example Prof Allyson Pollock, head of our health policy unit, said to me 'Gavin you can't go around promoting off-label prescribing it is simply not evidence-based'. The difference between her and me is that she didn't see the MSers ravaged by this disease, when they didn't have to be if they had had early access to effective DMTs. Isn't it better to use an off-label drug, supported by some evidence, albeit it not an official endorsement of a regulatory agency, than no treatment at all?"

"Please note a lot of the issues raised by this debate will be covered in our policy document and at the launch. If you haven't signed-up to attend the launch on Tuesday please do, it is promises to be an interesting evening."

CoI: multiple

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