Topic: Expert Opinion Paper

Disease Management Consensus Statement: Treatment Recommendations for Physicians

Issued by: The Medical Advisory Board of the National Multiple Sclerosis Society

By Kristin Jenkins

Several studies* show that even early MS relapses that appear benign may have neurological consequences. While these findings strengthen the argument for early intervention with a disease-modifying agent, unpublished data from the National MS Society-funded Sonya Slivka Longitudinal MS Study show that 38% of patients who report relapsing-remitting MS are not on immunomodulatory therapy.

In light of this, recommendations made by the Executive Committee of the Medical Advisory Board of the National Multiple Sclerosis Society for use of the current MS disease-modifying agents** include:

* Initiation of therapy with an immunomodulator should be considered as soon as possible following a definite diagnosis of MS with active disease, and may also be considered for selected patients with a first attack who are at high risk of MS.

* Patients’ access to medication should not be limited by frequency of relapses, age or level of disability.

* Treatment should not be stopped while insurers evaluate for continuing coverage of treatment.

* Therapy is to be continued indefinitely, except when there is a clear lack of benefit, intolerable side effects or better therapy becomes available.

* All of the FDA-approved agents should be included in formularies and covered by third party payers so that physicians and patients can determine the most appropriate agent on an individual basis. Failure to do so is unethical and discriminatory.

* Movement from one immunomodulatory drug to another should occur only for medically appropriate reasons.

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* Trapp BD et al New England Journal of Medicine 1998; 338:278-285. Rudick RA et al Neurology 1999; 53:1698-704. Bjartmar C et al Current Opinion in Neurology 2001: 14:271-278; Peterson JW et al Annals of Neurology 2001; 50:389-400.

** Immunomodulators: beta interferon 1a-intramuscular (Avonex)

                                       beta interferon 1a-subcutaneous (Rebif)

                                       beta interferon 1b (Betaseron)

                                       glatiramer acetate (Copaxone)

     Immunosuppressant: mitoxantrone (Novantrone)