TY - JOUR
T1 - Practice guideline recommendations summary
T2 - Disease-modifying therapies for adults with multiple sclerosis
AU - Rae-Grant, Alexander
AU - Day, Gregory S.
AU - Marrie, Ruth Ann
AU - Rabinstein, Alejandro
AU - Cree, Bruce A.C.
AU - Gronseth, Gary S.
AU - Haboubi, Michael
AU - Halper, June
AU - Hosey, Jonathan P.
AU - Jones, David E.
AU - Lisak, Robert
AU - Pelletier, Daniel
AU - Potrebic, Sonja
AU - Sitcov, Cynthia
AU - Sommers, Rick
AU - Stachowiak, Julie
AU - Getchius, Thomas S.D.
AU - Merillat, Shannon A.
AU - Pringsheim, Tamara
N1 - Publisher Copyright:
Copyright © 2018 American Academy of Neurology
PY - 2018
Y1 - 2018
N2 - Objective To develop recommendations for disease-modifying therapy (DMT) for multiple sclerosis (MS). Methods A multidisciplinary panel developed DMT recommendations, integrating findings from a systematic review; followed an Institute of Medicine–compliant process to ensure transparency and patient engagement; and developed modified Delphi consensus–based recommendations concerning starting, switching, and stopping DMTs pertinent to people with relapsing-remitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndromes of demyelination. Recommendations were supported by structured rationales, integrating evidence from one or more sources: systematic review, related evidence (evidence not from the systematic review), principles of care, and inference from evidence. Results Thirty recommendations were developed: 17 on starting DMTs, including recommendations on who should start them; 10 on switching DMTs if breakthrough disease develops; and 3 on stopping DMTs. Recommendations encompassed patient engagement strategies and individualization of treatment, including adherence monitoring and disease comorbidity assessment. The panel also discussed DMT risks, including counseling about progressive multifocal leukoencephalopathy risk in people with MS using natalizumab, fingolimod, rituximab, ocrelizumab, and dimethyl fumarate; and made suggestions for future research to evaluate relative merits of early treatment with higher potency DMTs vs standard stepped-care protocols, DMT comparative effectiveness, optimal switching strategies, long-term effects of DMT use, definitions of highly active MS, and effects of treatment on patient-specified priority outcomes. This guideline reflects the complexity of decision-making for starting, switching, or stopping MS DMTs. The field of MS treatment is rapidly changing; the Academy of Neurology development process includes planning for future updates.
AB - Objective To develop recommendations for disease-modifying therapy (DMT) for multiple sclerosis (MS). Methods A multidisciplinary panel developed DMT recommendations, integrating findings from a systematic review; followed an Institute of Medicine–compliant process to ensure transparency and patient engagement; and developed modified Delphi consensus–based recommendations concerning starting, switching, and stopping DMTs pertinent to people with relapsing-remitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndromes of demyelination. Recommendations were supported by structured rationales, integrating evidence from one or more sources: systematic review, related evidence (evidence not from the systematic review), principles of care, and inference from evidence. Results Thirty recommendations were developed: 17 on starting DMTs, including recommendations on who should start them; 10 on switching DMTs if breakthrough disease develops; and 3 on stopping DMTs. Recommendations encompassed patient engagement strategies and individualization of treatment, including adherence monitoring and disease comorbidity assessment. The panel also discussed DMT risks, including counseling about progressive multifocal leukoencephalopathy risk in people with MS using natalizumab, fingolimod, rituximab, ocrelizumab, and dimethyl fumarate; and made suggestions for future research to evaluate relative merits of early treatment with higher potency DMTs vs standard stepped-care protocols, DMT comparative effectiveness, optimal switching strategies, long-term effects of DMT use, definitions of highly active MS, and effects of treatment on patient-specified priority outcomes. This guideline reflects the complexity of decision-making for starting, switching, or stopping MS DMTs. The field of MS treatment is rapidly changing; the Academy of Neurology development process includes planning for future updates.
UR - http://www.scopus.com/inward/record.url?scp=85046794788&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046794788&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000005347
DO - 10.1212/WNL.0000000000005347
M3 - Review article
C2 - 29686116
AN - SCOPUS:85046794788
SN - 0028-3878
VL - 90
SP - 777
EP - 788
JO - Neurology
JF - Neurology
IS - 17
ER -