First European MS treatment guideline. Part two: switching treatments

People with MS commonly try several different disease-modifying therapies (DMTs) before their disease is adequately controlled. The first European MS clinical practice guideline highlights consensus among neurologists for switching treatments when there is evidence of disease activity.1  

In this, the second article in a two-part series, we take a closer look at recommendations that relate to switching treatments. Part one of the series focused on how the recommendations were formulated and what the guideline says about treatment and monitoring.

Interferons and glatiramer acetate are older treatments for relapsing–remitting MS, approved during the 1990s. Newer DMTs – those approved since 2000 – have effects mediated by different mechanisms from older DMTs. There is a growing evidence base that supports superior efficacy of several newer DMTs compared with that of older DMTs.2

The new guideline states that people with relapsing–remitting MS who show evidence of disease activity when treated with interferon or glatiramer acetate should be offered a more effective DMT; the evidence for this is considered strong. Moreover, although there is insufficient evidence for a formal recommendation, a consensus statement notes that when treatment with a highly effective DMT is stopped owing to a suboptimal treatment response or safety concerns, treatment with a different highly effective therapy should be considered. However, the guideline does not give a recommended time frame for switching treatments. In research to be published later this year, neurologists involved in MS Brain Health research to develop global standards for MS care suggest that if a patient’s response to their current DMT is judged to be suboptimal, an appropriate, alternative DMT should be offered within 4 weeks.3 This target is considered by the neurologists to be achievable in most healthcare systems.3

The treatment guideline is due to be updated in 5 years; although, the authors state this update could be earlier if there are substantial changes in the evidence on the included DMTs or if new therapies are approved. Such evidence-based updates will be crucial for the publication to retain relevance.

References

  1. Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Eur J Neurol. 2018;25:215–237; doi:10.1111/ene.13536.
  2. Giovannoni G, Butzkueven H, Dhib-Jalbut S, et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord. 2016;9 Suppl 1:S5–S48; doi;10.1016/j.msard.2016.07.003.
  3. Hobart J, Bowen A, Eberhard L, et al. Expert consensus on standards for multiple sclerosis care: preliminary results from a modified Delphi process [poster]. Presented at the 7th Joint ECTRIMS–ACTRIMS meeting, 25–28 October 2017, Paris, France.

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