Individualizing Disease-Modifying Therapy Selection in Newly Diagnosed MS: Gabrielle Macaron, MD

WATCH TIME: 5 minutes

"Younger age and short disease duration are both considered to be positive treatment effect modifiers in the sense that they are associated with better treatment response, specifically for a higher efficacy medication."

A recent expert-led session, chaired by Scott D. Newsome, DO, MSCS, FAAN, FANA, addressed the increasingly complex landscape of disease-modifying therapy (DMT) selection in multiple sclerosis (MS). Presented at the 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 28-31, 2025, in Phoenix, Arizona, the session opened with Newsome outlining current treatment approaches and evolving clinical considerations, followed by Gabrielle Macaron, MD, who focused spoke on the initial decision-making process when starting a DMT, emphasizing patient-specific factors such as age, disease activity, and risk tolerance.

Further into the session, Jiwon Oh, MD, PhD, FRCPC, provided insight into the rationale and strategies for switching therapies, highlighting scenarios involving suboptimal response, safety concerns, or lifestyle changes. Following Oh’s presentation, the session concluded with a dynamic panel roundtable featuring real-world case presentations and an audience-engaged Q&A, offering practical insights into navigating therapeutic decisions in an era of expanding MS treatment options. To dive deeper into this session on DMTs, Macaron, an assistant professor in the Department of Neuroscience at Université de Montréal, sat down with NeurologyLive® at the meeting to offer more insight on her talk given.

In the interview discussion, Macaron outlined the multifactorial considerations that can guide DMT selection in patients newly diagnosed with MS. She emphasized in the conversation the impact of patient age, disease duration, and lesion burden on prognosis and treatment efficacy, highlighting that younger patients with active disease may benefit from early initiation of high-efficacy therapies. Additionally, she addressed the challenges of treating older patients with MS, including increased risks related to immunosenescence and comorbidities. Other important factors such as family planning, treatment adherence, and drug access, she noted, also could play a crucial role in therapeutic decision-making.

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REFERENCES
1. Macaron G. Decision Making Process Around What DMT to Start. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, AZ. Era of Too Many Choices: Starting and Switching.