Navigating choice in multiple sclerosis management
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(2019) 1:5
Neurological Research and Practice
REVIEW
Open Access
Navigating choice in multiple sclerosis management Ralf A. Linker1*
and Andrew Chan2
Abstract Background: With the advent of modern immunotherapies for relapsing-remitting multiple sclerosis (RRMS) and the increasing amount of treatment options on the market, MS has evolved as a treatable disease. Yet, at the same time, new challenges for the treating neurologists arise. Main body: This review article covers some of these challenges, including when and how to start treatment, treatment monitoring, and finally considerations on what the increasing choice in treatment options brings to disease management and longer-term planning. Among others, these important issues comprise pregnancy, treatment sequencing, switching or even stopping treatment. Conclusion: The ultimate goal for navigating choices in RRMS management is to choose the right drug for the right patient at the right time Throughout the article, there is a strong focus on practical aspects and individual decision making in MS to meet the concept of personalized medicine. Keywords: MS therapy, Immunomodulation, Personalized medicine, Treatment monitoring, Disease management
Background In the past 5 years, more than five new treatment options entered the stage for immunotherapy of relapsing-remitting multiple sclerosis (RRMS), expanding the treatment armamentarium to more than a dozen substances in total [9]. Some of these compounds represent reformulations of already existing treatment options while others make use of bona fide new treatment concepts [11, 33]. While there is still no cure for MS yet and many unmet needs like optimal treatment of chronic progressive disease stages abound, RRMS has evolved as a treatable condition. In fact, considerable evidence points at long-term effects of modern immunotherapies on disability and also quality of life in cohorts of mostly younger RRMS patients (e.g. for beta interferons, [22]). Yet, with the advent of modern RRMS immunotherapy, new challenges for the treating neurologists arise. In this review, we will cover some of these new aspects including when and how to start treatment, treatment monitoring, and finally considerations on what the increasing choice in treatment options brings to disease management and * Correspondence: [email protected] 1 Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany Full list of author information is available at the end of the article
longer-term planning including important issues like pregnancy, treatment sequencing, switching or even stopping treatment. Throughout the article, there will be a strong focus on practical aspects and individual decision making to meet the concept of personalized medicine [19]. How to deal with increasing numbers of disease modifying therapies?
When thinking about treatment choices for RRMS, it is appropriate to discuss if the ever-expanding range of new disease modifying therapies (DMT) is really useful or if it is just making
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