Two surveys of American multiple sclerosis (MS) specialists reveal a general consensus of practice patterns in primary and secondary progressive MS, relapsing-remitting MS, and clinically isolated syndrome.
AMSTERDAM—Neurologists from multiple sclerosis (MS) treatment centers across the US generally agree on the use of spinal MRI or lumbar puncture for diagnosis of the disease, but more research regarding treatment responses and therapies is needed, according to the results of two studies presented at the 5th Joint Triennial Congress of the European Committee for Treatment and Research in Multiple Sclerosis/Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS/ACTRIMS).
“The current research effort was conducted with the goal of gaining an understanding of the current diagnostic and treatment practices of MS specialists at US MS treatment centers,” the investigators stated. The surveys were designed to determine the influence and use of various diagnostic and clinical parameters in clinical decisions pertaining to disease-modifying therapy initiation, switching, and selection.
The team of researchers, led by Omar A. Khan, MD, from the Department of Neurology at Wayne State University in Detroit, and Carlo Tornatore, MD, from the Department of Neurology at Georgetown University in Washington, DC, invited neurologists from 207 MS treatment centers to participate in the study. Two web-based surveys evaluating practice patterns for various forms of MS were developed and distributed to specialists; 75 specialists completed the first survey, and 71 of those completed the second survey.
CIS, RIS, and RRMS
The investigators presented participating MS specialists with patient scenarios regarding clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and radiologically isolated syndrome (RIS). Regarding CIS, the MS specialists reached a clear consensus (more than 75%)—MRI lesions are considered predictive of disease activity and a follow-up MRI within three to six months is important to confirm treatment effect. Optic neuritis alone was viewed as insufficient for initiating therapy. Glatiramer acetate and interferon beta were the most common initial therapy choices for CIS.
When treating RRMS with mild symptoms, most respondents also chose interferon beta and glatiramer acetate as their preferred initial therapy choices. “Treatment-naive patients with RRMS are generally started on a disease-modifying therapy,” the researchers concluded. “Disease-modifying therapies are generally switched with three or more new lesions on brain MRI over 12 months.”
The survey respondents also reached a consensus that MRI change over 12 months is a criterion for switching therapies in patients with RRMS and breakthrough disease, despite treatment with a first-line disease-modifying therapy. When interferon beta was used to treat these patients, there was a general trend toward using natalizumab as the disease progressed. For RIS, survey respondents agreed that “a spinal cord MRI is generally performed as part of the diagnostic evaluation,” and that lumbar puncture does not seem to have a major diagnostic role.
“For RRMS, the data suggested that with growing clinical experience and an increasing variety of therapeutic options, physicians may feel more confident in the use of more complex agents and treatment regimens,” the investigators stated. “The finding that nearly all respondents would perform a follow-up MRI for RIS reflects physician recognition that some patients with RIS will develop clinically definite MS and suggests that this cohort should be monitored for MRI lesion progression or evidence of clinical MS disease activity."
—Ariel Jones