Patients with multiple sclerosis who do not achieve adequate disease control on initial treatment require a defined next-line approach. This protocol addresses exactly that clinical situation — when the first disease-modifying therapy has not met its goals.
The prior line offered a standard disease-modifying therapy (DMT) with the goals of reducing clinical relapses and eliminating new MRI lesion activity. Escalation to this protocol is indicated when those targets — relapse reduction and absence of new MRI lesions — were not achieved.
The evidence-based next step involves switching to a higher-efficacy class of disease-modifying therapy. Which agents apply and the full selection algorithm are contained in the complete protocol.
DOI: 10.1212/WNL.0000000000005347
Although all possible clinical scenarios cannot be answered by drug trials, current evidence supports higher efficacy of alemtuzumab, natalizumab, fingolimod, and ocrelizumab compared with previously approved self-injectable DMTs.
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