May 1, 2018
AAN releases practice guideline for starting, switching, and stopping disease-modifying therapies
Background: Disease modifying therapies (DMT) for multiple sclerosis (MS) share many features including reducing relapse rates, maintaining or reducing the level of disability, and reducing the number of new or enhancing lesions as measured using magnetic resonance imaging. As with any medication, each DMT has its own set of adverse effects which can range from bothersome to potentially life-threatening. With 14 DMTs approved in Canada for the treatment of relapsing forms of MS, physicians and people diagnosed with MS can choose from different DMTs based on the mechanism of action the way a medication works to manage the disease), risk profile, route of administration, and monitoring requirements. Navigating the complexities of choosing a DMT while considering lifestyle, current health, and monitoring during the treatment course have created a need for guidelines that help physicians and individuals with MS so that informed treatment choices can be made.
Practice Guideline Recommendations for DMTs for Adults with MS
The American Association of Neurology (AAN) released practice guideline recommendations to help physicians and people living with MS choose among the approved DMTs. The guidelines, developed by a panel of experts and individuals living with MS, summarize different DMTs based on published evidence on their safety and efficacy profiles and make recommendations on when to start, switch and stop therapy.
Starting a DMT: MS typically worsens over time, therefore, starting a DMT early is currently the best defense against the effects of the disease. Several DMTs have “strong” or “moderate” evidence for reducing relapse rates.
Switching a DMT: Despite proper adherence to a DMT, some people with MS will experience disease activity, or ongoing relapses and MRI activity. For these individuals, the guidelines recommend switching to another DMT with a different mechanism of action. Currently there isn’t enough evidence available to determine which DMT a person should switch to, therefore an informed decision in consultation between an individual and their healthcare team should be made when switching depending on the risk vs. benefits of DMTs as well as the individuals lifestyle and personal preferences.
Stopping a DMT: Very little evidence is available on the risks and benefits of stopping a DMT. The guidelines mention that some people whose MS is stable, may consider stopping DMT use, however, individuals should discuss the decision with their healthcare team prior to stopping treatment. Additionally, physicians may advise stopping a DMT in people with secondary progressive MS who have not experienced a relapse for at least two years and have an EDSS of 7 or greater.
Resources for healthcare professionals and individuals with MS
AAN developed supporting documents to help healthcare professionals and people living with MS better understand the guidelines to make informed decisions. In addition to a publication on the guidelines and a clinician summary, individuals with MS can also access patient-friendly summaries on starting, switching and stopping DMT use.