TY - JOUR
T1 - Recognizing and treating suboptimally controlled multiple sclerosis
T2 - Steps toward regaining command
AU - Freedman, Mark S.
AU - Cohen, Bruce
AU - Dhib-Jalbut, Suhayl
AU - Jeffery, Douglas
AU - Reder, Anthony T.
AU - Sandberg-Wollheim, Magnhild
AU - Weinstock-Guttman, Bianca
N1 - Funding Information: All peer reviewers receive honoraria from CMRO for their review work. Peer reviewer 1 has disclosed that he/she has a grant partially supported by Wyeth Consumer Healthcare for a subject unrelated to the topic of this paper, however Pfizer recently acquired Wyeth. Peer reviewer 2 has disclosed that he/she has grants from Genzyme, Genentech, and sanofi-aventis.
PY - 2009/10
Y1 - 2009/10
N2 - 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 disease- and 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.
AB - 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 disease- and 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.
KW - Disease management
KW - Disease progression
KW - Drug therapy
KW - Relapsing-remitting multiple sclerosis
KW - Treatment failure
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U2 - https://doi.org/10.1185/03007990903158364
DO - https://doi.org/10.1185/03007990903158364
M3 - Review article
C2 - 19678753
SN - 0300-7995
VL - 25
SP - 2459
EP - 2470
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 10
ER -