Active Relapsing-Remitting MS with Ongoing Clinical Relapses and Brain MRI Activity After Initial Disease-Modifying Therapy

Clinical Scenario

This protocol applies to patients with active relapsing-remitting multiple sclerosis who continue to experience clinical relapses and MRI activity — including contrast-enhancing lesions or new/unequivocally enlarging T2 lesions on brain MRI — despite having received an initial disease-modifying drug.

Insufficient Response to Prior Therapy

The preceding step involved early treatment with a disease-modifying drug — selected from a spectrum ranging from modestly effective to highly efficacious agents — chosen according to patient characteristics, comorbidities, disease severity and activity, and drug safety profile. Escalation to this protocol is warranted when the required treatment targets are not met: persistence of clinical relapses, disability progression, or MRI activity (new or enlarging T2 lesions, or gadolinium-enhancing lesions) on standardised brain MRI at 6 and 12 months from treatment onset.

Next Treatment Step

For patients with evidence of ongoing disease activity on their initial therapy, the approach involves switching to a more efficacious disease-modifying drug — selected in consultation with the patient and informed by individual characteristics and disease severity. Which options are appropriate and how the choice is made is detailed in the full protocol.

Instant Access to Structured Evidence-Based Regimens

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).

Offer a more efficacious drug to patients treated with interferon or glatiramer acetate who show evidence of disease activity assessed as recommended in questions 4–5 of this guideline.

View source ↗