scholarly journals Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

2020 ◽  
Vol 47 (4) ◽  
pp. 437-455 ◽  
Author(s):  
Mark S. Freedman ◽  
Virginia Devonshire ◽  
Pierre Duquette ◽  
Paul S. Giacomini ◽  
Fabrizio Giuliani ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Working Group ◽  
Response To Therapy ◽  
Treatment Optimization ◽  
Course Of Disease ◽  
Disease Modifying Therapies ◽  
Potential Safety ◽  
Future Potential ◽  
Treatment Sequencing ◽  
Monitoring Response

Abstract:The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.

scholarly journals Results of Expert Council meeting on modern principles of treatment optimization in patients with relapsing-remitting multiple sclerosis using anti-CD20 monoclonal antibody

2021 ◽  
Vol 13 (3) ◽  
pp. 131-136
Author(s):  
A. N. Boyko ◽  
N. V. Khachanova ◽  
D. S. Korobko ◽  
D. S. Kasatkin ◽  
Ya. V. Vlasov ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Plasma Cells ◽  
Risk Groups ◽  
Response To Therapy ◽  
Treatment Optimization ◽  
Correct Treatment ◽  
Neuron Damage ◽  
Single Standard ◽  
Anti Cd20 ◽  
Myelin Antigens

The article presents the results of the discussion of the use of anti-B-cell therapy in multiple sclerosis (MS). These cells play a significant role in immunoregulation in MS, not only by producing antibodies to myelin antigens after transformation into plasma cells, but also by presenting the antigen to T cells, producing activation cytokines, and forming laminar follicles. The article provides an expert consensus statement on different drugs of this class in the MS treatment. In addition, the possibilities of determining the disease prognosis for the initially correct treatment choice are highlighted. Undoubtedly, there is a need for confirmation of the MS diagnosis, possible stratification of patients into different risk groups, and evaluation of the response to therapy. Potential additional research methods included evoked potentials and optical coherence tomography, baseline vitamin D3 level as a prognostic marker of the disease course, neurofilament levels in serum and cerebrospinal fluid to confirm neuron damage. However, it takes much time to study, determine the methodology, reference values, and develop a single standard approach to identify and implement a biomarker, which should then be implemented in routine clinical practice.

scholarly journals Treatment Optimization in MS: Canadian MS Working Group Updated Recommendations

2013 ◽  
Vol 40 (3) ◽  
pp. 307-323 ◽  
Author(s):  
Mark S. Freedman ◽  
Daniel Selchen ◽  
Douglas L. Arnold ◽  
Alexandre Prat ◽  
Brenda Banwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Working Group ◽  
Current Approach ◽  
Treatment Optimization ◽  
Disability Status ◽  
Rational Choices ◽  
Medium Level ◽  
Level Of Concern ◽  
High Level ◽  
Practical Recommendations

The Canadian Multiple Sclerosis Working Group (CMSWG) developed practical recommendations in 2004 to assist clinicians in optimizing the use of disease-modifying therapies (DMT) in patients with relapsing multiple sclerosis. The CMSWG convened to review how disease activity is assessed, propose a more current approach for assessing suboptimal response, and to suggest a scheme for switching or escalating treatment. Practical criteria for relapses, Expanded Disability Status Scale (EDSS) progression and MRI were developed to classify the clinical level of concern as Low, Medium and High. The group concluded that a change in treatment may be considered in any RRMS patient if there is a high level of concern in any one domain (relapses, progression or MRI), a medium level of concern in any two domains, or a low level of concern in all three domains. These recommendations for assessing treatment response should assist clinicians in making more rational choices in their management of relapsing MS patients.

Long-Term Treatment Optimization in Individuals with Multiple Sclerosis Using Disease-Modifying Therapies

2004 ◽  
Vol 36 (1) ◽  
pp. 10-22 ◽  
Author(s):  
Lorraine Denis ◽  
Marie Namey ◽  
Kathy Costello ◽  
Jocelyne Frenette ◽  
Nathalie Gagnon ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Term Treatment ◽  
Treatment Optimization ◽  
Disease Modifying Therapies ◽  
Long Term Treatment ◽  
Disease Modifying

scholarly journals Disability improvement as a clinically relevant outcome in clinical trials of relapsing forms of multiple sclerosis

2021 ◽  
pp. 135245852110002
Author(s):  
Bruce AC Cree ◽  
Jeffrey A Cohen ◽  
Anthony T Reder ◽  
Davorka Tomic ◽  
Diego Silva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Therapeutic Benefit ◽  
Disease Modifying Therapies ◽  
Long Term Follow Up ◽  
Post Hoc ◽  
Switch Group ◽  
Relevant Outcome

Background: Disease-modifying therapies (DMTs) can reduce the risk of disability worsening in patients with relapsing forms of multiple sclerosis (RMS). High-efficacy DMTs can lead to confirmed or sustained disability improvement (CDI and SDI). Objective and Methods: Post hoc analyses of data from the TRANSFORMS, FREEDOMS, and FREEDOMS II trials and their extensions assessed the effects of fingolimod (0.5–1.25 mg/day) on stabilizing or improving disability over ⩽8 years in participants with RMS. CDI and SDI rates were compared between participants initially randomized to fingolimod, interferon (IFNβ-1a), or placebo. Results: At 8 years’ follow-up in TRANSFORMS, 35.1% (95% confidence interval [CI], 28.2%–43.1%) of assessed participants in the IFNβ-1a–fingolimod switch group and 41.9% (36.6%–47.6%) on continuous fingolimod experienced CDI; disability did not worsen in approximately 70%. Similar results were seen in the combined FREEDOMS population. Proportionally fewer TRANSFORMS participants achieved SDI in the IFNβ-1a–fingolimod switch group than on continuous fingolimod (5.4% [3.0%–9.5%] vs 14.2% [10.8%–18.4%], p = 0.01). Conclusion: CDI and SDI are outcomes of interest for clinical trials and for long-term follow-up of participants with RMS. Monitoring CDI and SDI in addition to disability worsening may facilitate understanding of the therapeutic benefit of RMS treatments.

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