What is the recommended treatment for multiple sclerosis?

From the Guidelines

The most effective treatment approach for multiple sclerosis (MS) involves a combination of disease-modifying therapies (DMTs), symptomatic treatments, and lifestyle modifications, with a strong emphasis on regular monitoring with MRI scans and neurological examinations to assess treatment efficacy and disease activity. When considering the treatment of MS, it's crucial to tailor the approach to the specific type of MS and individual patient factors, including the use of MRI for drug surveillance programmes to screen for opportunistic infections, unexpected disease activity, and comorbidities 1. For patients with relapsing-remitting MS, first-line treatments often include injectable medications like interferon beta or glatiramer acetate, or oral options such as fingolimod, dimethyl fumarate, and teriflunomide. Some key points to consider in the management of MS include:

• The use of natalizumab, which requires brain MRI screening every 3–4 months for patients at high risk of progressive multifocal leukoencephalopathy (PML) 1.
• The importance of sufficient dietary vitamin D intake and adequate sunlight exposure to ensure adequate vitamin D levels for the prevention of MS, with dietary supplementation recommended in cases of low vitamin D intake or levels 1.
• The role of symptomatic treatments in addressing specific issues like fatigue, spasticity, pain, and bladder dysfunction.
• The need for regular monitoring with MRI scans, particularly for patients switching from natalizumab to other therapeutics, who require enhanced pharmacovigilance, including brain MRI every 3–4 months for up to 12 months 1.

From the FDA Drug Label

AVONEX is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. TYSABRI is indicated as monotherapy for the treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

The recommended treatments for multiple sclerosis are:

• Interferon beta-1a (IM), with the brand name AVONEX, as indicated for the treatment of relapsing forms of MS 2
• Natalizumab (IV), with the brand name TYSABRI, as monotherapy for the treatment of relapsing forms of MS, but with a warning of increased risk of progressive multifocal leukoencephalopathy (PML) 3 Key points to consider when choosing a treatment:
• Indication: Both AVONEX and TYSABRI are indicated for relapsing forms of MS
• Administration: AVONEX is administered via intramuscular injection, while TYSABRI is administered via intravenous infusion
• Risk of PML: TYSABRI increases the risk of PML, and patients should be monitored for signs and symptoms of PML 3

From the Research

Treatment Options for Multiple Sclerosis

The treatment for multiple sclerosis (MS) typically involves disease-modifying therapies (DMTs) that aim to reduce the frequency of relapses and slow down the progression of the disease.

• First-line therapies, such as interferon-β and glatiramer acetate, have well-established efficacy and are generally considered safe 4.
• Second-line therapies, including natalizumab and fingolimod, may offer greater efficacy but are associated with a higher risk of adverse events 4, 5.
• The choice of therapy should be individualized, taking into account the patient's disease activity, progression, quality of life, and health economy, as well as their personal preferences and risk tolerance 4, 6.

Initiating and Switching Therapies

The decision to start or switch therapies should be based on a thorough evaluation of the patient's response to treatment and their overall disease course.

• Patients with inadequate response to first-line therapies may benefit from switching to a second-line therapy or another platform therapy 6, 5.
• Natalizumab initiators tend to stay on therapy longer and have fewer treatment gaps compared to platform initiators 5.
• Switching between platform therapies is common, despite evidence suggesting that patients may benefit from switching to natalizumab 5.

Adherence to Therapies

Adherence to DMTs is crucial for optimal disease management.

• High adherence rates have been reported among patients with MS, with 81.5% of patients taking their medication as prescribed 7.
• Factors influencing adherence include the type of DMT, patient attitudes, and relationships with healthcare providers 7, 8.
• Interferon beta and glatiramer acetate have been shown to be effective and well-tolerated, with a long history of use in relapsing-remitting MS 8.