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April 2015

Treatment Decisions for Patients With Active Multiple Sclerosis

Author Affiliations
  • 1Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas
  • 2Neurology Section, VA North Texas Health Care System, Medical Service, Dallas
  • 3Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  • 4Associate Editor, JAMA Neurology
  • 5Department of Systems Medicine, Multiple Sclerosis Clinical and Research Center, Tor Vergata University and Hospital, Rome, Italy
  • 6Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Santa Lucia, Centro Europeo di Ricerca sul Cervello, Rome, Italy
JAMA Neurol. 2015;72(4):387-389. doi:10.1001/jamaneurol.2014.4494

In the complex scenario of current multiple sclerosis (MS) treatment options, it is becoming imperative for clinicians to have the instruments to make prompt treatment decisions for patients who have a suboptimal response, in order to avoid that the MS progresses to such an extent that any therapy adjustment would no longer be effective. How to modify treatment to achieve a better response can be a complex issue, and decisions should be made on the basis of a drug’s efficacy, safety, and tolerability. Before natalizumab and fingolimod were made available for the treatment of MS, many published experiences have tried to define the risks and advantages of switching among platform therapies (interferons to glatiramer acetate or vice versa). Overall, these studies show that switching among first-line therapies can be of some benefit in reducing disease activity, at least in the short term, for patients with breakthrough disease; however, the advantages of switching therapy owing to poor tolerability, and not to treatment failure, are less clear.1

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