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Optimizing Outcomes in Multiple Sclerosis – A Consensus Initiative

Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121

B Arnason

Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121

B Hurwitz

Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121

F Lublin

Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121

Background

Initiation of immunomodulators in patients experiencing a clinically isolated syndrome (CIS) may delay progression to clinically definite MS. However, lack of consensus remains on many issues affecting optimal management of MS.

Method

A panel of 21 MS experts met during 9 meetings to explore key issues in MS and CIS. Meetings addressed 3 phases: 1. CIS definition and diagnosis; 2. initial therapy; and 3. monitoring disease progression and treatment efficacy. Newsletters covering each phase were sent to 5000 U.S.-based neurologists who were invited to participate in an online survey on key issues.

Results

Most panel members agreed that early treatment may minimize neurodegeneration and most would recommend it for patients; that a dose-response relationship exists for beta-interferon therapy; that more aggressive therapy was most effective early in the disease course; and, that MRI has a role in monitoring disease progression. In face of suboptimal response, most would switch patients to a different therapy; while combination therapy would be reserved for those failing monotherapy regimes. Most online survey respondents agreed with these positions.

Conclusions

There was uniform consensus from this panel of MS experts that early initiation of immunomodulator therapy was beneficial for CIS patients.

Key Words: clinically isolated syndrome • copolymer 1 • interferon beta 1a • interferon beta 1b • McDonald Criteria • mitoxantrone • multiple sclerosis • natalizumab

Multiple Sclerosis, Vol. 15, No. 2 Suppl, S5-S35 (2009)
DOI: 10.1177/1352458508101134


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