Active Relapsing-Remitting MS with Clinical Relapses and Brain MRI Activity
This protocol covers the management of active relapsing-remitting multiple sclerosis (RRMS) characterised by ongoing clinical relapses alongside objective evidence of inflammatory activity on brain MRI — specifically contrast-enhancing lesions or new and unequivocally enlarging T2 lesions.
Clinical Scenario
Active RRMS defined by clinical relapses and brain MRI activity: contrast-enhancing lesions and/or new or unequivocally enlarging T2 lesions on brain MRI. Early intervention is indicated to limit ongoing inflammatory damage.
Treatment Approach — Partial Overview
Early initiation of a disease-modifying drug is indicated, chosen from agents that range from modestly effective to highly efficacious and selected on the basis of patient characteristics, comorbidities, disease severity and activity, and the drug’s safety and accessibility profile. The complete selection algorithm and regimen detail are available in the full protocol.
Treatment Goals
- Absence of clinical relapses and disability progression
- No new or unequivocally enlarging T2 lesions on brain MRI
- No gadolinium-enhancing lesions on brain MRI
- Response assessed via standardised brain MRI within 6 months of treatment onset, compared with a further scan at 12 months
References
DOI: 10.1177/1352458517751049
- Offer early treatment with DMDs to patients with active RRMS as defined by clinical relapses and/or MRI activity (active lesions–contrast-enhancing lesions; new or unequivocally enlarging T2 lesions assessed at least annually).
- Also includes CIS fulfilling current diagnostic criteria for MS.
- For active RRMS, choosing between the wide range of available drugs from the modestly effective to the highly efficacious, will depend on the following factors, in discussion with the patient.
- When monitoring treatment response in patients treated with DMDs, perform a standardized reference brain MRI usually within 6 months of treatment onset and compare it with a further brain MRI performed typically 12 months after starting treatment.
- When monitoring treatment response in patients treated with DMDs, the measurement of new or unequivocally enlarging T2 lesions is the preferred MRI method supplemented by GAD-enhancing lesions for monitoring treatment response.
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