The assistant professor of medicine at University of Toronto, and neurologist at St. Michael's Hospital spoke about the process of changing or beginning treatment with a variety of disease-modifying therapies in multiple sclerosis. [WATCH TIME: 4 minutes]
WATCH TIME: 4 minutes
"There are a number of different things we have to consider when we’re making a decision about treatment. When we have that conversation with patients, we always want to talk about the patient’s personal preferences in terms of their comfort level with risk. Some of our medications have some rare, but serious, potential adverse events long term, so we always want to talk about the safety profile of the medication. We also always want to talk about access issues."
In recent years, the decision-making process for choosing a therapy in multiple sclerosis (MS) has evolved rapidly as a result of increasing shared decision-making practices as well as a better understanding of the optimization of disease-modifying therapies (DMTs) for these patients, particularly for those who are treatment-naïve. When considering a given therapy, neurologists such as Dalia Rotstein, MD, MPH, often begin by diving into the prognostic information that they can collect on a given patient.
Rotstein, who is an assistant professor of medicine at University of Toronto, and neurologist at St. Michael's Hospital, told NeurologyLive® that some of the factors she considers include demographic information—such as age, sex, and ethnicity—as well as clinical features of the patient’s disease—such as attack frequency and localization, degree of recovery, and MRI markers. More severe disease, she said, often leads physicians to utilize more high-efficacy therapies, whereas those with more moderate disease might be started on an immunomodulator with escalation over time, as needed.
At the 2022 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, Rotstein presented on the topic of choosing DMTs and switching to a high-efficacy DMT in a time-appropriate fashion. In this conversation, she shared her perspective on and approach to the use of these treatments, as well as provided an overview of the different pros and cons of switching to certain therapies over others.