What is multiple sclerosis?

From the Guidelines

The most effective approach to managing multiple sclerosis (MS) involves a combination of disease-modifying therapies, symptom management, and lifestyle modifications, with a strong emphasis on regular monitoring using MRI to assess disease progression and treatment response. When it comes to MS management, the goal is to reduce morbidity, mortality, and improve quality of life. The use of MRI in MS goes beyond diagnosis, as it can help stage patients, measure disease progression, and predict long-term disability 1. Key aspects of MS management include:

• Disease-modifying therapies such as interferon beta medications, glatiramer acetate, or newer oral options like fingolimod, dimethyl fumarate, or teriflunomide
• Symptom management with corticosteroids for acute flare-ups, and medications for specific symptoms like spasticity, fatigue, and neuropathic pain
• Lifestyle modifications including regular exercise, adequate rest, stress management, and avoiding excessive heat
• Regular monitoring using MRI to assess disease progression and treatment response, as recommended by the MAGNIMS consensus guidelines 1 The MAGNIMS guidelines provide recommendations on how and when to use MRI for disease monitoring, and discuss promising MRI approaches that may be introduced into clinical practice in the near future 1. By prioritizing regular MRI monitoring and personalized treatment approaches, healthcare providers can help improve outcomes and quality of life for individuals with MS. In terms of specific treatment options, the choice of disease-modifying therapy will depend on the individual patient's needs and circumstances, with stronger medications like natalizumab or ocrelizumab reserved for more aggressive MS. Overall, a comprehensive and multidisciplinary approach to MS management is essential for reducing morbidity, mortality, and improving quality of life.

From the Research

Treatment Options for Multiple Sclerosis

• Multiple sclerosis (MS) is a chronic and often disabling autoimmune disease that affects the central nervous system 2.
• Disease-modifying therapies (DMTs) are used to reduce the frequency and severity of MS relapses, with interferons (IFNs) being one of the first-line treatment options 2, 3.
• Interferon beta (IFNβ) has been shown to reduce relapse rates and delay the onset of disability in patients with relapsing forms of MS 2.
• Other treatment options include glatiramer acetate (GA) and natalizumab, which have been compared to IFNs in terms of efficacy and safety 3, 4, 5.

Efficacy and Safety of Treatment Options

• Studies have shown that IFNs and GA have similar clinical efficacy in reducing relapse rates and disease progression 5.
• However, IFNs have been found to limit the increase in lesion burden on magnetic resonance imaging (MRI) compared to GA 5.
• Natalizumab has been shown to be effective in reducing relapse rates and delaying disease progression, especially in patients who have failed other treatments 3.
• The most common adverse events associated with IFN treatment include injection site reactions and flu-like symptoms, which can be managed with patient education and mitigation strategies 2.

Treatment Patterns and Persistence

• Treatment patterns among patients with MS vary, with some patients switching from one DMT to another due to issues with tolerability or efficacy 6.
• Persistence with DMTs is generally low, with only about half of patients remaining on their initial treatment after one year 6.
• Switching to an oral DMT has been associated with higher persistence rates and lower odds of relapse compared to injectable DMTs 6.