As a result of ongoing research, more treatment choices in MS care are available than ever before. In this video, “Treatment Choices in MS Care: Which is the Correct Disease-Modifying Therapy?,” Drs. Lisak and Cohen discuss the benefits and risks of several DMTs. Using results from clinical trials, MRI data, and discussion around case studies, this CME offering from the virtual education site NeuroSeriesLive will provide you with increased knowledge and a better understanding of treatment choices in MS care.
Dr. Bruce Cohen, MD, FAAN, FANA, FACP, Professor of Neurology at Northwestern University’s Feinberg School of Medicine hosts a presentation and discussion by Dr. Robert Lisak, MD, FRCP (E), FAAN, FANA, Parker Webber Chair in Neurology, Professor of Neurology and of Immunology and Microbiology at Wayne State University School of Medicine surrounding Interferon B-1a, glatiramer acetate, natalizumab, and combinations of therapies.
The Decision to Treat
After discussing Case Study #1, Dr. Lisak asks viewers to decide if there are any other diagnostic tests that should be considered, what the first therapeutic intervention might be, how we want to initiate treatment, and if we do decide to treat the patient, what treatment choice would we choose? Dr. Lisak reminds us as we move along the path to treatment we need to consider several criteria including efficacy versus safety versus tolerability, risk assessment, patient similarity to clinical study patients, patient history and preferences, and separating fact from fiction/marketing.
In an unbiased manner, using results from clinical trials presented using comparison graphs, Drs. Lisak and Cohen explain to viewers the benefits of initiating treatment with each of the options currently available. Emphasis is placed on dosing and frequency variables showing short and long-term outcomes. Comparison study results are shown between single medication options and combination therapy regiments, giving providers more choices to help their patients achieve the ultimate goal of no evidence of disease activity.
Which Treatment Choice is Best?
Dr. Lisak doesn’t stand by a particular treatment choice for MS, but rather examines several options and shows results from clinical trials of each, basing results on criteria such as patients not converting to clinically definite multiple sclerosis (CDMS), percentage of disease activity free, and proportions of patients with sustained progression of disability.
Dosing options for Fingolimod (a relatively new, oral route medication) are compared against serious adverse events including death, cardiovascular disorders, infection, neoplasms, and respiratory disorders. Contrasts between Alemtuzumab and Interferon are shown using the expanded disability status scale (EDSS) and relapse rates using differing dosing options with Alemtuzumab.
Cautionary advice is given for clinical trial results, stressing the importance of keeping results within proper and appropriate frames of reference; your patient might not match the medical profiles of those in the trials, so results will vary to some degree. Drs. Lisak and Cohen agree that new trials, (after 2002), show that event rate (relapse) is significantly less than those prior to 2002. Dr. Cohen states, “even placebo groups in current trials do better than some of the treated groups in early trials.”
Questions and Answers
Time is given toward the end of the presentation for questions from viewers of the original program. The point of caution is raised concerning the exclusive use of data results to formulate treatment choice; weight must be given to signs and symptoms and patient history/preference. Certain comorbidities that limit treatment choice are mentioned, statements about various blood tests, and basic versus individualized care when treating patients are other topics discussed during this portion of the course. Both providers agree, “the worst thing you can do for a patient is to hand them a list [of options] and say, ‘pick one.'”
Upon completion of the CME “Treatment Choices in MS Care: Which is the Correct Disease-Modifying Therapy?,” viewers will be better able to offer tailored treatment choices for their patients and be able to engage them in informative discussions regarding their care.
Disclaimer: All PlatformQ Health articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.