From the Guidelines
The treatment approach for patients with benign Multiple Sclerosis (MS) should focus on monitoring rather than aggressive therapy, with regular neurological assessments every 6-12 months and annual MRI scans to monitor for new lesions. Benign MS patients, who maintain minimal disability (typically EDSS score ≤3.0) after 10-15 years of disease, generally require less intensive treatment than those with more active forms 1. First-line disease-modifying therapies like interferon beta (Avonex, Rebif, Betaseron) or glatiramer acetate (Copaxone) may be considered if there is evidence of disease activity, as they are generally well-tolerated with manageable side effect profiles.
Key Considerations
- Symptom management remains important, addressing issues like fatigue, cognitive changes, or mild sensory symptoms as they arise.
- The rationale for this conservative approach is that benign MS patients have demonstrated a naturally favorable disease course with minimal progression, and the risk-benefit ratio of more aggressive therapies may not favor intervention.
- However, it's crucial to recognize that the "benign" classification can change over time, as some patients initially classified as having benign MS may develop more significant disability later, necessitating regular reassessment and potential treatment adjustments if disease activity increases.
Recent Guidelines
Recent guidelines from ECTRIMS and the EBMT support the use of autologous haematopoietic stem cell transplantation (AHSCT) for treatment of relapsing–remitting MS that is refractory to conventional disease-modifying therapies (DMTs) 1. However, this approach is not typically recommended for benign MS patients, as the risk-benefit ratio may not favor intervention.
Monitoring and Follow-up
Follow-up MRI scans should be conducted at least once every year in patients with MS, but patients at risk of serious treatment-related adverse events may need to be monitored more frequently, for example, every 3–4 months 1. Accurate positioning of follow-up and reference scans is essential for the accurate assessment of changes in lesion size and number over time.
From the Research
Definition and Characteristics of Benign MS
- Benign Multiple Sclerosis (MS) refers to a subgroup of MS patients who show little or no progression in the severity of the disease over time 2.
- This condition has been recognized since the 1950s, and research indicates a multifactorial background in disease severity.
- It is still difficult to predict whether the course will be benign at onset, and factors that influence the course of the disease over time are not well understood.
Treatment Approach for Benign MS
- There is no specific treatment approach mentioned in the studies for patients with benign MS, as the focus is on relapsing-remitting MS and disease-modifying therapies.
- However, the studies discuss treatment strategies for patients with relapsing-remitting MS, including switching to another first-line disease-modifying therapy (DMT) or a second-line DMT if there is a suboptimal response to initial therapy 3, 4.
- The choice of treatment depends on the individual patient's benefits and risks, and the aim is to achieve the best long-term outcomes.
Disease-Modifying Therapies for MS
- Several immunomodulatory and immunosuppressive therapeutic agents are available for relapsing forms of MS, including beta-interferons, glatiramer acetate, fingolimod, natalizumab, and alemtuzumab 3.
- These agents have different mechanisms of action, efficacy, and safety profiles, and the choice of treatment depends on the individual patient's characteristics and disease activity.
- Studies have shown that initial treatment with fingolimod, alemtuzumab, or natalizumab is associated with a lower risk of conversion to secondary progressive MS compared to initial treatment with glatiramer acetate or interferon beta 5.