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

Research output: Contribution to journalReview article

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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; Weinstock-Guttman, Bianca.

In: Current Medical Research and Opinion, Vol. 25, No. 10, 2009, p. 2459-2470.

Research output: Contribution to journalReview article

Harvard

Freedman, MS, Cohen, B, Dhib-Jalbut, S, Jeffery, D, Reder, AT, Sandberg Wollheim, M & Weinstock-Guttman, B 2009, 'Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command', Current Medical Research and Opinion, vol. 25, no. 10, pp. 2459-2470. https://doi.org/10.1185/03007990903158364

APA

Freedman, M. S., Cohen, B., Dhib-Jalbut, S., Jeffery, D., Reder, A. T., Sandberg Wollheim, M., & Weinstock-Guttman, B. (2009). Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command. Current Medical Research and Opinion, 25(10), 2459-2470. https://doi.org/10.1185/03007990903158364

CBE

Freedman MS, Cohen B, Dhib-Jalbut S, Jeffery D, Reder AT, Sandberg Wollheim M, Weinstock-Guttman B. 2009. Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command. Current Medical Research and Opinion. 25(10):2459-2470. https://doi.org/10.1185/03007990903158364

MLA

Vancouver

Author

Freedman, Mark S. ; Cohen, Bruce ; Dhib-Jalbut, Suhayl ; Jeffery, Douglas ; Reder, Anthony T. ; Sandberg Wollheim, Magnhild ; Weinstock-Guttman, Bianca. / Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command. In: Current Medical Research and Opinion. 2009 ; Vol. 25, No. 10. pp. 2459-2470.

RIS

TY - JOUR

T1 - Recognizing and treating suboptimally controlled multiple sclerosis: 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

PY - 2009

Y1 - 2009

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 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.

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 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.

KW - Drug therapy

KW - Disease management

KW - Disease progression

KW - Relapsing-remitting multiple sclerosis

KW - Treatment failure

U2 - 10.1185/03007990903158364

DO - 10.1185/03007990903158364

M3 - Review article

VL - 25

SP - 2459

EP - 2470

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 1473-4877

IS - 10

ER -