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Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command

Freedman, Mark S.; Cohen, Bruce; Dhib-Jalbut, Suhayl; Jeffery, Douglas; Reder, Anthony T.; Sandberg Wollheim, Magnhild LU and Weinstock-Guttman, Bianca (2009) In Current Medical Research and Opinion 25(10). p.2459-2470
Abstract
Objective: The therapies available today for multiple sclerosis (MS) reduce but do not fully control disease activity. The objective of this article is to review the definitions of and treatments for suboptimally controlled MS and highlight the challenges faced by clinicians to increase awareness of recognizing and managing patients with suboptimally controlled MS. Methods: Published literature describing treatment failure, treatment optimization paradigms or algorithms, clinical studies of therapies in patients with suboptimally controlled MS, or case reports of management of patients with suboptimally controlled MS were identified from searches of EMBASE and MEDLINE. This was supplemented with case reports and discussions from an expert... (More)
Objective: The therapies available today for multiple sclerosis (MS) reduce but do not fully control disease activity. The objective of this article is to review the definitions of and treatments for suboptimally controlled MS and highlight the challenges faced by clinicians to increase awareness of recognizing and managing patients with suboptimally controlled MS. Methods: Published literature describing treatment failure, treatment optimization paradigms or algorithms, clinical studies of therapies in patients with suboptimally controlled MS, or case reports of management of patients with suboptimally controlled MS were identified from searches of EMBASE and MEDLINE. This was supplemented with case reports and discussions from an expert panel meeting of MS specialists focused on the diagnosis and treatment of suboptimally controlled MS. Results: Several groups have created recommendations for evaluating suboptimal response to disease- modifying drugs (DMDs) in MS. Currently no robust evidence- based data exist to guide treatment decisions in patients who have suboptimal response to a particular therapy. In the absence of data, several treatment paradigms for suboptimally controlled MS have been proposed using a step therapy or platform therapy approach. Therapy modifications require consideration of diseaseand patient-specific factors while accounting for the risk-benefit profile of the agent(s). Unapproved drugs and combination therapies should be reserved as agents of last resort because of the experimental nature of these treatments. Conclusions: In the absence of evidence-based data, identifying and treating MS patients with suboptimal response to the available platform therapies remains challenging. Developing algorithms able to quantify breakthrough disease activity and suboptimal response to DMDs in individual MS patients remains an important target for the MS community. Consideration should be given for all reasons why a particular DMD may not be working for a given patient and for the use of an individualized step therapy. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Drug therapy, Disease management, Disease progression, Relapsing-remitting multiple sclerosis, Treatment failure
in
Current Medical Research and Opinion
volume
25
issue
10
pages
2459 - 2470
publisher
LibraPharm
external identifiers
  • wos:000269931100013
  • scopus:70350098361
ISSN
1473-4877
DOI
10.1185/03007990903158364
language
English
LU publication?
yes
id
a2e49a7f-e709-403b-85c9-234012540a6b (old id 1490737)
date added to LUP
2009-10-19 13:10:44
date last changed
2017-07-09 03:32:29
@article{a2e49a7f-e709-403b-85c9-234012540a6b,
  abstract     = {Objective: The therapies available today for multiple sclerosis (MS) reduce but do not fully control disease activity. The objective of this article is to review the definitions of and treatments for suboptimally controlled MS and highlight the challenges faced by clinicians to increase awareness of recognizing and managing patients with suboptimally controlled MS. Methods: Published literature describing treatment failure, treatment optimization paradigms or algorithms, clinical studies of therapies in patients with suboptimally controlled MS, or case reports of management of patients with suboptimally controlled MS were identified from searches of EMBASE and MEDLINE. This was supplemented with case reports and discussions from an expert panel meeting of MS specialists focused on the diagnosis and treatment of suboptimally controlled MS. Results: Several groups have created recommendations for evaluating suboptimal response to disease- modifying drugs (DMDs) in MS. Currently no robust evidence- based data exist to guide treatment decisions in patients who have suboptimal response to a particular therapy. In the absence of data, several treatment paradigms for suboptimally controlled MS have been proposed using a step therapy or platform therapy approach. Therapy modifications require consideration of diseaseand patient-specific factors while accounting for the risk-benefit profile of the agent(s). Unapproved drugs and combination therapies should be reserved as agents of last resort because of the experimental nature of these treatments. Conclusions: In the absence of evidence-based data, identifying and treating MS patients with suboptimal response to the available platform therapies remains challenging. Developing algorithms able to quantify breakthrough disease activity and suboptimal response to DMDs in individual MS patients remains an important target for the MS community. Consideration should be given for all reasons why a particular DMD may not be working for a given patient and for the use of an individualized step therapy.},
  author       = {Freedman, Mark S. and Cohen, Bruce and Dhib-Jalbut, Suhayl and Jeffery, Douglas and Reder, Anthony T. and Sandberg Wollheim, Magnhild and Weinstock-Guttman, Bianca},
  issn         = {1473-4877},
  keyword      = {Drug therapy,Disease management,Disease progression,Relapsing-remitting multiple sclerosis,Treatment failure},
  language     = {eng},
  number       = {10},
  pages        = {2459--2470},
  publisher    = {LibraPharm},
  series       = {Current Medical Research and Opinion},
  title        = {Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command},
  url          = {http://dx.doi.org/10.1185/03007990903158364},
  volume       = {25},
  year         = {2009},
}