Expert consensus from the Arabian Gulf on selecting disease-modifying treatment for people with multiple sclerosis according to disease activity

Abstract

Recent research has expanded our understanding of the natural history and clinical course of multiple sclerosis (MS) in the Arabian Gulf region. In addition, the number of available therapies for MS has increased greatly in recent years, which complicates considerably the design of therapeutic regimens. We, an expert group of physicians practising in Arabian Gulf countries, present pragmatic consensus recommendations for the use of disease-modifying therapy, according to the level of MS disease activity, according to objective criteria, and prior treatment (if any) received by a given patient.

Real-world effectiveness and safety profile of teriflunomide in the management of multiple sclerosis in the Gulf Cooperation Council countries: An expert consensus narrative review

“…However, the practicing physicians may not always be constrained to them and decide to follow the local practice in the region. 13,14 Therefore, the experts on the panel shared their real-world experiences in treating patients with MS. These experiences, along with published literature, highlight teriflunomide safety and effectiveness, along with patient-related outcomes, pregnancy-related data, and patients with COVID-19 infection.…”

The Place of Immune Reconstitution Therapy in the Management of Relapsing Multiple Sclerosis in France: An Expert Consensus

“…A registry study in Sweden in 2020 used relapse rates in the real-world care setting to define high disease activity [ 33 ]. An expert group from the Arabian Gulf proposed categories of “active” RMS, “highly active” RMS and ”rapidly evolving severe” RMS, based on relapses, radiology findings and prognostic factors [ 34 ]. Finally, a recent (2020) Delphi consensus process considered that any people with RMS with at least two relapses in the previous year could have highly active RMS irrespective of other factors [ 35 ].…”

Position of Cladribine Tablets in the Management of Relapsing-Remitting Multiple Sclerosis: An Expert Narrative Review From the United Arab Emirates

“…Post hoc data are hypothesis generating and this finding requires confirmation, however. ''High disease activity'' is not well defined as a basis for therapeutic indications, and its definition for the therapeutic use of individual DMTs tends to reflect the patient populations of the Phase 3 trials that supported its introduction [72]. For the future, a more consistent definition of ''high disease activity'' in RRMS would be useful.…”

“…However, data so far do not support a clear or consistent adverse association between COVID-19 infection and adverse outcomes in subjects with MS who have received a DMT [71]. Accordingly, the experts supported a policy of continuing to manage their patients with MS as previously, including use of DMTs, as recommended by physicians elsewhere in the Middle East [72]. In general, the experts here did not consider the COVID-19 pandemic to represent a barrier per se to the use of cladribine tablets for a patient without symptoms of this condition, especially with regard to administration of the second annual treatment course.…”