- New American Academy of Neurology (AAN) guidelines incorporate most current evidence on disease-modifying therapies (DMTs) in adults with multiple sclerosis (MS).
Why this matters
- Guidelines last issued in 2002, and many new DMTs have become available since then.
- 30 recommendations on DMTs: 17 on starting, 10 on switching for breakthrough disease, 3 on stopping.
- Patients with first demyelinating event not meeting MS criteria but at high risk for progression, and patients with relapsing forms of MS having recent disease activity should be offered DMTs.
- In untreated patients with clinically isolated syndromes or relapsing forms of MS quiescent for 2 years, clinicians may recommend annual imaging instead.
- Patients on DMTs experiencing disease activity should be counseled about option of switching to another DMT.
- Evidence on stopping DMTs in stable relapsing-remitting MS is limited; given natural history of disease, clinicians should encourage DMT continuation.
- Editorialists write, “These statements serve as guidelines for MS patient care; however, they do not replace the clinician-patient relationship in which the most informed decision rests.”
- Recommendations by multidisciplinary expert panel drawing on evidence from a comprehensive systematic review that extracted data from 20 Cochrane reviews, 73 full-text articles.
- Funding: American Academy of Neurology.