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December 2018

Deciding on the Best Multiple Sclerosis Therapy: Tough Choices

Author Affiliations
  • 1Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Neurol. 2018;75(12):1461-1462. doi:10.1001/jamaneurol.2018.2689

As of January 1, 2018, there are 18 US Food and Drug Administration (FDA)–approved therapies for relapsing-remitting multiple sclerosis (MS) with more on the horizon. For many reasons, no algorithm for treatment has been widely accepted and, to our knowledge, few have been proposed. The treating neurologist cannot use a prescriptive approach for managing MS because none exists. Discussing the panoply of disease-modifying treatments (DMTs) with the patient who has just received a diagnosis or with one that needs to switch therapies because of a lack of efficacy, adverse effects or events, or injection fatigue can be exhausting and unsatisfying. There are always uncertainties regarding the future course of the disease, the completeness of the response to the DMTs, and the risk and benefit analysis for each. How is this best approached?

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