Clinical management of multiple sclerosis: the treatment paradigm and issues of patient management.

OBJECTIVE To summarize the conclusions of an expert panel of neurologists specializing in multiple sclerosis (MS) convened for the purpose of creating a treatment algorithm with regard to the clinical management of MS. The panel was sponsored by the Health Science Center for Continuing Medical Education and the University of Medicine and Dentistry of New Jersey and supported by an educational grant from Biogen Idec, Inc. SUMMARY MS is a chronic demyelinating disease characterized by a variable clinical course. Currently, there is no cure for MS, and the management of MS requires lifelong treatment with disease-modifying agents. Some patients respond well to therapy for many years, whereas others may have aggressive disease that is more difficult to manage. Hence, given the variable nature in the course of MS and patients. response to treatment, neurologists must individualize care for their patients. An MS treatment algorithm was recently developed by a panel of neurologists who are MS experts to provide community neurologists with best-practice protocols for treating and managing their MS patients. The panel of experts categorized MS into 3 different stages, with patients transitioning between the stages based on their response to therapy and disease progression. Stage I represents MS early in the progression of the disease, during which platform drug therapy is recommended (i.e., interferon beta-1b [IFNbeta-1b], IFNbeta-1a, or glatiramer acetate). The results of randomized, controlled clinical trials suggest that IFNbeta is the optimal choice for platform therapy. Despite treatment with platform therapy, it is common for patients to experience some ongoing symptoms and periodic exacerbations of the disease (annual relapse rate of 0.59 to 0.84 on treatment); such relapses should not be considered treatment failures and are best managed with steroids. Stage II represents acute breakthrough disease (i.e., when the clinical activity becomes more frequent or severe). This stage is best managed by the addition of pulse corticosteroids to the platform drug. Stage III represents continued breakthrough disease and is best managed by the addition of immunosuppressants to the platform drug. CONCLUSION The MS treatment algorithm provides an educational resource for physicians. It should assist all health care professionals involved in the management of MS patients and enhance their ability to improve quality of life for these patients over the course of the disease.