Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

Abstract

Abstract:The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.

Recommendations for switching patients with highly active multiple sclerosis from other disease modifying drugs for multiple sclerosis to cladribine tablets

“…В ходе подготовки рекомендаций по переключению пациентов с других ПИТРС на кладрибин в таблетках использовался многоступенчатый консенсусный подход. На основании данных литературы [3][4][5]15], результатов клинических исследований и реальной клинической практики применения кладрибина в таблетках [8][9][10][11][12]16, 17], а также очного обсуждения был подготовлен проект рекомендаций по переключению пациентов с ПИТРС первой и второй линии, таких как интерферон β (ИФНβ), глатирамера ацетат (ГА), диметилфумарат, терифлуномид, финголимод, натализумаб, алемтузумаб, окрелизумаб и митоксантрон, на кладрибин в таблетках.…”

“…10 , Khabirov F.A. 16,17 а также обосновано максимально быстрое переключение на более эффективный ПИТРС при отсутствии ответа или субоптимальном ответе на терапию первой линии [5]. В настоящее время нет единых критериев субоптимального ответа и рекомендаций по смене терапии.…”

“…В публикации 2020 г. эксперты Канадской рабочей группы по изучению РС (Canadian Multiple Sclerosis Working Group) выделяют ряд «более значимых» клинических и МРТ-параметров при мониторинге терапии, наличие любого из которых рассматривается как показание к смене препарата (табл. 1) [5].…”

Navigating the TOR of Multiple Sclerosis

“…In this issue of CJNS, the Canadian Multiple Sclerosis Working Group (CMSWG) unveil a contemporary edition of Treatment Optimization Recommendations (TOR). 1 Similar to a geographical tor or summit, the TOR are a culmination or peak of current knowledge in multiple sclerosis (MS). This collaborative effort is a guide written by expert clinicians based on available evidence rather than formal clinical practice guidelines.…”

“…4 The current CMSWG recommendations provide guidance in the increasingly complex landscape of MS treatment. 1 As DMT options increase for relapsing MS, it is clear that key points include (1) recommending treatment initiation soon after diagnosis, (2) performing risk stratification to inform initial DMT selection, and (3) re-evaluating at regular intervals to enable escalation of therapy for suboptimal treatment response. There is increasing evidence that early initiation of therapy results in improved long-term outcome.…”