A multiple sclerosis expert, Dr Gabrielle Macaron, discusses factors that can lead to a change of therapy for patients with multiple sclerosis.
Gabrielle Macaron, MD: What factors lead to a change of disease-modifying therapy? In a nutshell, the answer is that patients with relapsing/remitting multiple sclerosis [MS] typically stay on their treatment if it’s working. Higher-efficacy disease-modifying therapies work better for most patients, and we typically don’t need to switch patients who are on this category of treatment based on efficacy. In practice, treatment response and efficacy are measured based on the presence or absence of clinical relapses; a worsening physical disability, which is most commonly measured by the EDSS [Expanded Disability Status Scale]; and new or enhancing lesions on follow-up MRIs. These 3 key criteria are grouped in a composite outcome measure, which is called NEDA, or no evidence of disease activity, which is commonly used in clinical research and practice. But defining treatment response isn’t as straightforward and several other factors might be necessary to take into account or take into consideration before we can decide if a patient should stay on a treatment or switch treatments. This area of the MS field is still a gray zone, and we don’t exactly know what factors are the most predictive of long-term positive treatment response.
Transcript edited for clarity