Advice for Clinical Management of Multiple Sclerosis

EP: 1.Brain and Cognitive Changes in Multiple Sclerosis

EP: 2.Association Between Brain Volume and Long-term Cognition in Relapsing Multiple Sclerosis

EP: 3.Cognitive Care Recommendations

EP: 4.Factors Necessitating Treatment Change in Multiple Sclerosis

EP: 5.Ozanimod in DMT Naïve vs Experienced Patients with Relapsing Multiple Sclerosis

EP: 6.Clinical Pearls for MS Management in Everyday Practice

EP: 7.Treatment Discontinuation in Multiple Sclerosis

EP: 8.Relapse Following Discontinuation of Ozanimod

EP: 9.Implications of Ozanimod Discontinuation Data for MS Care

EP: 10.Managing Relapses in Patients With Multiple Sclerosis

EP: 11.Long-Term Outcomes With Ozanimod Based on Number of MS Relapses

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EP: 12.Advice for Clinical Management of Multiple Sclerosis

Darin Okuda, MD: For the clinical management of individuals with multiple sclerosis [MS], I would bring up the following: One is we recently published our data involving medication discontinuation and waste in the MS field. What we identified was that in 60% of instances, people are transitioning from one treatment to another, not because it’s not effectively controlling their current disease—so it’s not because of recurrent relapses, MRI advancement, or neurological progression—but it’s because they don’t like the route of administration, they don’t like the frequency, they don’t like how these medicines feel, and they have a given perception of how it’s working for them. I think we really need to change the dialogue in the clinic.

It was eye-opening for me, and this work shows how patients at times are more honest with electronic platforms than they are in face-to-face interactions with their doctor. I think really getting deep down into opinions regarding how a given person with MS sees their current treatment is exceptionally valuable. I think we define success as clinicians in a very coarse way, which may not be ideal. We look for relapses, we look for MRI advancement, we look for neurological progression—that’s meaningful to us, but it may not be meaningful to patients. They may be looking at “Am I able to work effectively? Does this affect my sexual health? Can I afford this therapy? Will I have some cosmetic problem taking it? I am constantly traveling; I find this therapy to be an issue, but I don’t want to upset my doctor because he or she seems very excited about restarting this therapy.”

I think these lessons recently have allowed us to take a different approach regarding how we counsel patients. We know that these therapies aren’t cures but we know that they can get very close to them with respect to effective disease control. One of the best pieces of advice I would give another clinician is to really have a genuine conversation and to keep things real and to see if a particular treatment is truly working well within your patient’s lifestyle, because if it’s not, we have a problem. I can hit all those metrics that are meaningful to me; they may not be metrics meaningful to that person with multiple sclerosis, though.

Transcript edited for clarity