ClinicSpeak: sequencing DMTs

Are we ready to formulate DMT sequencing algorithms in MS? #MSBlog #MSResearch #ClinicSpeak

“The following is my presentation given to neurologists in Toronto, on Monday night, on the sequencing of DMTs in clinical practice. This is the first time I have given a talk on this topic. The presentation will have to evolve over time and needs more work. It is clear there is an unmet need regarding DMT sequencing data; we simply need more evidence to allow us to make rational decisions more carefully. MSers will need more guidance in this area; gone are the days when MSers could make a decision regarding treatments without much input from healthcare professionals.”

“The MS DMT space is beginning to look similar to that in rheumatoid arthritis. I am aware that there are treatment algorithms in RA but until we get more evidence of sequencing, in particular in relation to the more efficacious therapies, a lot of the guidance will be based on opinion and a scientific rationale, rather than being evidence-based. This will not be satisfactory in the long-term. Hopefully, national treatment registers and real-life data sources (e.g. MSBase) will provide the evidence we need to formulate treatment algorithms. I think that most neurologists are beginning to buy into the concept of treat-2-target of NEDA, with some agreeing that a zero tolerance strategy has its merits. It is how we achieve NEDA, as quickly as possible, in as many MSers as possible, safely that needs to be answered. Lack of access to DMTs, delayed referral for DMTs, not monitoring subclinical disease activity, spending too much time on low efficacy treatment tiers and denying MSers access to more active therapies due to safety concerns are the challenges we will need to overcome.”

CoI: multiple

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Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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