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Treatment Optimization in MS: Canadian MS Working Group Updated Recommendations

  • Mark S. Freedman (a1), Daniel Selchen (a2), Douglas L. Arnold (a3), Alexandre Prat (a4), Brenda Banwell (a5), Michael Yeung (a6), David Morgenthau (a2) and Yves Lapierre (a3)...

Abstract

The Canadian Multiple Sclerosis Working Group (CMSWG) developed practical recommendations in 2004 to assist clinicians in optimizing the use of disease-modifying therapies (DMT) in patients with relapsing multiple sclerosis. The CMSWG convened to review how disease activity is assessed, propose a more current approach for assessing suboptimal response, and to suggest a scheme for switching or escalating treatment. Practical criteria for relapses, Expanded Disability Status Scale (EDSS) progression and MRI were developed to classify the clinical level of concern as Low, Medium and High. The group concluded that a change in treatment may be considered in any RRMS patient if there is a high level of concern in any one domain (relapses, progression or MRI), a medium level of concern in any two domains, or a low level of concern in all three domains. These recommendations for assessing treatment response should assist clinicians in making more rational choices in their management of relapsing MS patients.

Résumé:

Le Canadian Multiple Sclerosis Working Group (CMSWG) a élaboré des recommandations pratiques en 2004 pour aider les cliniciens à optimiser l'utilisation des traitements modificateurs de la maladie chez les patients atteints de sclérose en plaques récurrente-rémittente (SPRR). Le CMSWG s'est réuni pour réviser comment est évaluée l'activité de la maladie, pour actualiser l'évaluation d'une réponse sous-optimale et pour suggérer un plan de changement ou d'intensification du traitement. Des critères pratiques pour évaluer les épisodes de récurrence ainsi que la progression telle qu'évaluée par l'Expanded Disability Status Scale (EDSS) et l'IRM ont été développés pour classifier le niveau de préoccupation clinique comme étant faible, moyen ou élevé. Le groupe a conclu qu'un changement de traitement peut être envisagé chez tout patient atteint de SPRR s'il existe de vives préoccupations dans l'un ou l'autre domaine, soit les épisodes de récurrence, la progression ou l'IRM, un niveau de préoccupation modéré dans deux domaines, ou un faible niveau de préoccupation dans les trois domaines. Ces recommandations pour l'évaluation de la réponse au traitement devraient aider les cliniciens à faire des choix plus rationnels dans la gestion des patients atteints de SPRR.

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Copyright

Corresponding author

University of Ottawa, Multiple Sclerosis Research Unit, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. Email: mfreedman@toh.on.ca

References

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