January 5th, 2004
Boston Cure Project
For people newly diagnosed with MS, the advice from the general medical community is clear and consistent: get on a disease-modifying drug as soon as possible. However, for those who go on treatment but still experience relapses or increasing disability, there is no consensus about how, when or whether to change what they're doing.
To help provide some guidance in this area to people with MS and their doctors, an international working group of MS physicians convened to develop some general guidelines for reconsidering therapy approaches. They considered a number of changes or events that may occur in someone on treatment (e.g., a relapse requiring hospitalization, new T1 lesions, or a change in EDSS) and classified them as "noteworthy," "worrisome," or "actionable." For example, a single mild relapse within one year would be only noteworthy, while two or more moderate or severe relapses would be actionable, and thus require reassessment of the treatment plan. Multiple noteworthy or worrisome changes might also indicate a need for reassessment.
Of course, a wide range of factors must be considered in making individual treatment decisions, and therefore it would probably be impossible to create a comprehensive set of guidelines. However, a simple framework like this one at least gives people with MS and their doctors something to start with when considering a change in treatment.
Copyright © 2004, Boston Cure Project