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Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

  • Mark S. Freedman (a1), Virginia Devonshire (a2), Pierre Duquette (a3), Paul S. Giacomini (a4), Fabrizio Giuliani (a5), Michael C. Levin (a6), Xavier Montalban (a7), Sarah A. Morrow (a8), Jiwon Oh (a7), Dalia Rotstein (a7) and E. Ann Yeh (a9)...

Abstract:

The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.

RÉSUMÉ :

L’optimisation des traitements destinés à la sclérose en plaques : les recommandations du Canadian Multiple Sclerosis Working Group.

Le Canadian Multiple Sclerosis Working Group (CMSWG) vient de mettre à jour ses recommandations visant à optimiser l’utilisation de médicaments modificateurs de l’évolution de l’état de santé de patients atteints de toutes les formes de sclérose en plaques (SP). Ces recommandations, rappelons-le, fournissent des lignes directrices quant à l’amorce d’un traitement efficace au début de la maladie mais aussi quant à un suivi de la réponse des patients à un traitement et à des modifications à un traitement, voire un nouveau traitement, dans le but d’optimiser le contrôle de la SP. Les recommandations actuelles ont également abordé le traitement des cas de SP affectant les enfants, la SP progressive ainsi que l’identification et le traitement de formes de la maladie davantage foudroyantes. Bien que les traitements plus récents offrent une efficacité accrue, des problèmes potentiels en matière de sécurité doivent aussi être pris en compte de façon adéquate, notamment lorsqu’une alternance de traitements (treatment sequencing) est envisagée. À noter que d’autres éléments de discussion et considérations ont été ajoutés par le CMSWG au sujet de la prise en charge des patientes enceintes, du potentiel des biomarqueurs dans le futur et du moment où il peut être prudent de cesser un traitement. Toutes ces recommandations sont destinées à être utilisées et interprétées par tous les neurologues qui nourrissent un intérêt particulier à l’égard de la prise en charge de la SP.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: Mark S. Freedman, HBSc MSc MD CSPQ FANA FAAN FRCPC, Professor of Medicine (Neurology), Ottawa, Ontario, Canada. Email: mfreedman@toh.ca

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Keywords

Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

  • Mark S. Freedman (a1), Virginia Devonshire (a2), Pierre Duquette (a3), Paul S. Giacomini (a4), Fabrizio Giuliani (a5), Michael C. Levin (a6), Xavier Montalban (a7), Sarah A. Morrow (a8), Jiwon Oh (a7), Dalia Rotstein (a7) and E. Ann Yeh (a9)...

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