Long-Term Management of MS: Monitoring Progression and Supporting Patient Wellness While on Anti-CD20 DMTs

In this episode titled "Long-Term Management of MS: Monitoring Progression and Supporting Patient Wellness While on Anti-CD20 DMTs," Dr. Williams asks the panel what the clinical conversation looks like for patients who have been on therapy for five to seven or more years — and what new priorities have emerged.

Dr. Greenberg describes a shift in focus: visits that were once dominated by relapse management and medication counseling now center on cancer screening, lifestyle optimization (exercise, nutrition), and monitoring for subtle progression over time. He notes that the freedom from relapse activity has opened time to address the "whole person" — conversations that were crowded out when managing acute disease burden.

A major theme is detecting progression independent of relapse activity (PIRA). Dr. Greenberg has implemented patient-driven monitoring: patients perform a six-minute walk test three to five times per year at home and record their results, enabling detection of meaningful trends over time.

Dr. Krieger highlights the value of bringing a caregiver, family member, or close friend — what he calls a "truth teller" — to clinical visits. Patients may underestimate or misremember functional changes over a six-month interval; an independent observer provides crucial additional data. He describes a clinic setup specifically designed to capture non-verbal cues from the companion while maintaining patient-centered focus. Technology-enabled self-tracking through fitness apps also contributes to this 360-degree functional assessment.

In the next episode, "Choosing Among Anti-CD20 Therapies in MS: Patient Profiles and Clinical Decision Making," the panel identifies specific clinical scenarios that favor one anti-CD20 agent over another.