What is the next step in treatment for a multiple sclerosis patient currently in maintenance therapy?

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Last updated: June 14, 2025 • View editorial policy

From the Guidelines

The next step in treatment for a multiple sclerosis patient currently in maintenance therapy should be to consider autologous haematopoietic stem cell transplantation (AHSCT) if the patient has aggressive forms of relapsing–remitting MS that are refractory to disease-modifying therapy (DMT). This recommendation is based on the recent consensus statement from the European Committee for Treatment and Research in Multiple Sclerosis and the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party, published in 2025 1.

Key Considerations

  • AHSCT is a generally accepted indication for patients with relapsing forms of MS that are refractory to DMT, particularly after failure of high-efficacy DMT in aggressive forms of relapsing–remitting MS.
  • The optimal placement of AHSCT in the treatment sequence is not universally agreed upon, but it is considered for patients with rapidly evolving, severe, treatment-naive MS, progressive MS, and neuromyelitis optica spectrum disorder (NMOSD).
  • Treatment and monitoring protocols, rehabilitation, and other supportive care before and after AHSCT need to be optimized.

Treatment Approach

  • For patients with stable MS and no new symptoms, relapses, or MRI lesions, continuing the current maintenance therapy is appropriate.
  • However, if breakthrough disease activity occurs, treatment escalation should be considered, which may involve switching to higher-efficacy options such as natalizumab, ocrelizumab, ofatumumab, or fingolimod.
  • Specific medication changes should be individualized based on the patient's MS subtype, comorbidities, and risk factors.

Monitoring and Follow-up

  • Regular follow-up with neurological examinations every 3-6 months and MRI scans annually is essential to assess treatment efficacy.
  • Addressing symptom management for issues like fatigue, spasticity, or bladder dysfunction with appropriate medications and rehabilitation should be part of the comprehensive treatment plan.
  • Treatment decisions should balance disease control with safety considerations and patient preferences, as recommended by the recent consensus statement 1.

From the FDA Drug Label

The provided drug labels do not directly address the next step in treatment for a multiple sclerosis patient currently in maintenance therapy.

The FDA drug label does not answer the question.

From the Research

Next Steps in Treatment for Multiple Sclerosis Patients in Maintenance Therapy

For a multiple sclerosis patient currently in maintenance therapy, the next steps in treatment can vary depending on the disease course and activity.

  • The concept of induction followed by long-term maintenance treatment has been explored in several studies 2, suggesting that this approach can provide rapid reduction in disease activity and sustained disease control.
  • Induction therapy with mitoxantrone or alemtuzumab, followed by maintenance therapy with an immunomodulatory treatment such as interferon-β or glatiramer acetate, has been shown to be effective in reducing disease activity and slowing disease progression 2.
  • Other immunosuppressive drugs, such as natalizumab and ocrelizumab, have also been shown to be effective in treating highly active MS patients, but their mechanism of action is different from induction therapy 2.
  • Interferon beta-1b has been used as a disease-modifying therapy in multiple sclerosis for many years, and its efficacy and long-term safety profile have been well established 3, 4, 5.
  • Peginterferon beta-1a, a newer form of interferon beta-1a, has been shown to be cost-effective compared to interferon beta-1a and glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis 6.

Considerations for Treatment Decisions

When considering the next steps in treatment for a multiple sclerosis patient in maintenance therapy, several factors should be taken into account, including:

  • Disease activity and progression
  • Treatment history and response to previous therapies
  • Patient preferences and lifestyle
  • Potential side effects and risks associated with different treatments
  • Cost-effectiveness of different treatment options 6

Treatment Options

Some potential treatment options for multiple sclerosis patients in maintenance therapy include:

  • Continuing current therapy if it is effective and well-tolerated
  • Switching to a different disease-modifying therapy if current therapy is not effective or is not well-tolerated
  • Adding a new therapy to the current treatment regimen
  • Considering induction therapy with a drug such as mitoxantrone or alemtuzumab, followed by maintenance therapy with an immunomodulatory treatment 2

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.