April 23, 2018

WSU MS expert helps draft new guidelines that recommend patients begin drug therapy sooner

For most patients, it's better to start taking drugs for multiple sclerosis early rather than letting the disease run its course, according to a new guideline for treating MS from the American Academy of Neurology and developed with the input of a Wayne State University School of Medicine expert in the disease.

The new guideline is published in the April 23 online issue of Neurology®, the medical journal of the American Academy of Neurology, and presented at the 70th AAN annual meeting in Los Angeles this week. The guideline is endorsed by the Multiple Sclerosis Association of America and the National Multiple Sclerosis Society.

"The guidelines and the comprehensive review of the literature that accompanies the guidelines, provide up to date information based on an admittedly imperfect literature, on managing disease modifying therapies for patients with multiple sclerosis," said Robert Lisak, M.D., F.A.A.N., F.R.C.P., professor of Neurology and of Microbiology, Immunology and Biochemistry for the Wayne State University School of Medicine. "It is also important because it reminds neurologists what we know and what we still do not know about treating patients with MS."

Dr. Lisak, representing both WSU and the Consortium of Multiple Sclerosis Centers, served on the AAN Guideline Development, Dissemination and Implementation Subcommittee that wrote the new guidelines for disease-modifying therapy for multiple sclerosis. The Consortium of Multiple Sclerosis Centers is a professional organization of MS centers and health care providers and researchers in the United States and Canada committed to a comprehensive multidisciplinary approach to treatment and care, education and research and advocacy for MS so that the centers can provide the best care and outcomes for patients and their families. The consortium also is an international clearinghouse for research results, the latest treatments, clinical trials and patient education programs.

For the guideline, experts from the American Academy of Neurology carefully reviewed available scientific studies on the use of MS drugs. They found that starting an MS drug as early as possible may be better than letting MS run its course. This is because the disease is known to worsen over time. According to the guideline, several MS drugs have either strong or moderate evidence supporting their use for slowing certain disease processes.

While MS drugs may help slow and stabilize the disease process, some people with MS may experience a return of disease activity while using an MS drug. According to the guideline, if that happens, patients may need to switch to a different drug shown to have less risk of the disease returning.

The guideline experts also noted that some people whose MS is stable may think about stopping drug use if they have no signs of the disease. According to the guideline, very few studies have been done on the benefits or risks of stopping MS drugs.

Dr. Lisak noted that the prior guidelines, which date to about 2002, were outdated considering new approved therapies. "The earlier guidelines only dealt with the original so-called platform therapies and with natalizumab. Since then there have been multiple new approved therapies and newer dosing regimens of some of the older treatments. These guidelines deal with the newer and older treatments. We also deal with the issues of when to start therapy, when to consider switching therapies and when to consider stopping therapies," he said.

The guidelines provide neurologists a comprehensive review of the literature about the available agents, both approved and those used off-label, as well as recommendations on relative efficacy, when to start, when to consider switching and when to consider stopping disease-modifying therapies, Dr. Lisak said. They also provide guidelines on monitoring patients and their medications.

Multiple sclerosis affects about 400,000 Americans and is a leading cause of disability among young adults. The chronic inflammatory condition affects the central nervous system. People with MS experience vision problems, muscle weakness, bladder or bowel dysfunction, tremors, trouble with coordination, and cognitive and emotional problems.

Unlike some treatments, which only help manage symptoms, disease-modifying therapies are drugs that can alter or change the course of MS for patients. While they are not a cure, they can reduce the number of relapses a person has and slow the process of MS.

The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with 34,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.

Learn more about multiple sclerosis at www.BrainandLife.org, the American Academy of Neurology's patient and caregiver magazine and website.