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Best practices offer guidance on treating MS in an evolving landscape
Recent developments in treating MS have created the need for an updated set of best practices, according to a presentation at the 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 27–30 in Indianapolis.
Choosing the optimal MS therapy has become more complex, given the availability of more than 10 treatments with seven mechanisms of action, said Corey Ford, MD, of the Multiple Sclerosis Specialty Clinic at the University of New Mexico. Also, MS is now the second most expensive diagnosis for health-care payers, who have gained a prominent role in making treatment decisions.
“In the absence of consensus guidelines of any kind, I’m sure you’ve all experienced the payers who decide that if you don’t tell them what the best thing to do is, they have the right to decide what that is,” Dr. Ford said. In an effort to address this need, he chaired a group that recently developed algorithms to guide MS clinicians in their treatment decisions.
The presentation reviewed these algorithms, which were published in the International Journal of MS Care in October 2014. They cover treatment of relapsing remitting MS, clinically isolated syndrome and patients with an aggressive onset or poor prognosis.
The group also offered guidance for switching disease modifying therapy (DMT) due to lack of efficacy, which is a common scenario for clinicians. Dr. Ford noted in the presentation that up to 50 percent of patients will discontinue their therapy for this reason. Fourteen percent of patients switch DMTs three or more times.
Before switching drugs, the clinician should assess whether the new option will be a good fit for the patient. This includes exploring whether the patient was adherent to the current drug, and whether the patient is willing to undergo any regular monitoring that’s needed, which could present a barrier to adherence.
Dr. Ford emphasized that the time has come for professional organizations like the CMSC to unite in insisting that drug prices be moderated for the benefit of stakeholders including patients, physicians treating MS, and third party payers.
He concluded with the call to action that the best practices group issued in their paper. Clinicians need “a more consistent approach to the management of the disease. We can update this as more drugs come online, and we can sharpen the recommendations as we get more information about comparative studies,” he said. MS specialists also need “guidance on how to sequence drugs to minimize complications in a world where we now have 10 to 12 drugs going on, and 14 to 15 in the near future.”