AAN updates guidelines on disease-modifying therapies for MS

  • Neurology

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.”

Study design

  • 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.

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