Treatment algorithms for MS - Modifying Therapies

Our chair Dr Rosie Jones shares her thoughts on ‘Treatment Algorithms for Multiple Sclerosis Disease-Modifying Therapies’ (full document here)- an important document recently released by NHS England which updates the current guidance for medical professionals on drugs and other therapeutic approaches in early relapse/remitting MS.

Over the last two decades, we have progressed from having virtually no effective treatment for MS to the situation today where neurologists treating MS are faced with a whole range of drugs that are effective in slowing the progression of early MS. Some are more potent than others, and more effective drugs may also carry a higher risk of more intrusive side effects. Careful management of all patients on any of the Disease Modifying Drugs (DMDs) is vital.
As well as reviewing and updating information on current practice the document contains important messages about what services should be available for those who are in the early stages of MS. In its section on “Principles of Organisation of MS Disease Modifying Services” the document makes several important points:

• Patients should be at the centre of any Disease Modifying Treatment (DMT) services

• Every region should make available all licensed drugs available to all eligible patients based on the nature and severity of their MS.

• The minimum team for prescribing and managing patients on DMTs should be at least one MS Specialist Neurologist and one MS Specialist Nurse. However, it is noted that a Multi-Disciplinary Team (MDT) comprising a range of healthcare professionals is preferable.

Meeting these laudable aims is not always easy especially in rural areas of low population density and supporting a full MDT is not always possible in smaller treatment centres.
To help Neurological teams to meet the demands of treatment with Disease Modifying Drugs (DMDs) the document points out that there are local and national support networks enabling doctors and nurses to inform and audit their practice.

The new document will support and encourage best practice in prescribing and managing people with MS who are using any of the DMTs. It also makes some landmark statements about treating children who have MS and the introduction of newer approaches to treatment such as stem cell treatments. Such treatments are very much in their infancy, but the document anticipates the possible development of important new centres of expertise where such treatments can be delivered safely.

MS Research suggests that people who are on any of the DMTs can help their medical team by noting any major changes in their experience of MS or its progress. It is important to attend all appointments for treatment and assessment.

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