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Optimizing Treatment Outcomes

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In this article


See the Multiple Sclerosis Coalition's evidence-based consensus paper entitled The Use of Disease-Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence. 

Optimizing treatment outcomes with disease-modifying therapies involves several factors:

Initiating the appropriate treatment at the appropriate time.

  • Most MS specialists advocate for early intervention, although differences of opinion exist within the MS community:
  • The following image of the natural history of MS indicates the significant amount of MRI activity that occurs in the pre-clinical phase and early relapsing-remitting MS, the gradual decrease in inflammatory attacks (relapses) over time, and the increasing MRI burden of disease that occurs along with a decrease in brain volume. This schematic supports the role of DMTs early in the disease course.

CMS_ms.natural.history (.png)


Consensus criteria

Consensus Criteria for Sub-Optimal Response (Cohen et al., 2004)

  • No relapse rate reduction or > 1 relapse/year after 6-12 months of continuous DMT
  • Recurrent or new spinal cord or brainstem lesions
  • Incomplete recovery from repeated relapses, especially when EDSS (.pdf) score increases
  • Progressive cognitive or motor impairment that disrupts ADLs regardless of neurological exam changes (eliminating the influence of medications, depression, or superimposed concurrent illness)
  • Polyregional disease development that affects multiple neurologic systems