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Review
. 2016 Jan;13(1):47-57.
doi: 10.1007/s13311-015-0412-4.

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

Jens Ingwersen  1 , Orhan Aktas  1 , Hans-Peter Hartung  2
Affiliations
Review

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

Jens Ingwersen et al. Neurotherapeutics. 2016 Jan.

Abstract

Treatment options in relapsing-remitting multiple sclerosis have increased considerably in recent years; currently, a dozen different preparations of disease-modifying therapies are available and some more are expected to be marketed soon. For the treating neurologist this broad therapeutic repertoire not only greatly improves individualized management of the disease, but also makes choices more complex and difficult. A number of factors must be considered, including disease activity and severity, safety profile, and patient preference. We here discuss the currently existing options and suggest treatment algorithms for managing relapsing-remitting multiple sclerosis.

Keywords: Disease-modifying therapy; Relapsing-remitting multiple sclerosis; Treatment algorithm; Treatment decisions.

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Figures

Fig. 1
Fig. 1
Suggested treatment algorithm in relapsing-remitting multiple sclerosis (RR-MS). Patients with low or intermediate disease activity should use one of the baseline disease-modifying therapies (DMTs) of interferon (IFN)-β, glatiramer acetate (GA), dimethyl fumarate (DMF), or teriflunomide (Teri). The decision for one of them is based on a number of considerations (side effects, convenience, wish for children, etc.). Patient with aggressive MS (high disease activity) can start with one of the escalation DMTs, stratified by JC virus (JCV) status. JCV antibody-negative patients should preferably start with natalizumab or fingolimod, JCV antibody-positive patients preferably with fingolimod or alemtuzumab. Patients that are already on baseline therapy can switch to another baseline DMT when encountering tolerability issues. At breakthrough disease, patients should be treated as patients with high disease activity (i.e., stratified by JCV antibody status). Modified according to [107]. *According to Plavina et al. antibody indices may accurately predict PML risk in natalizumab [65]. The index is increasingly used for stratification, but should be used with caution until validated in independent samples. IM = intramuscular; SC = subcutaneous; DM = dimethyl; MRI = magnetic resonance imaging
See this image and copyright information in PMC

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