Treatment of Multiple Sclerosis with Active MRI Brain Lesions and Clinical Relapses
Active relapsing-remitting MS is characterised by both clinical relapses and radiological disease activity on brain MRI. When this combined picture is present, early disease-modifying treatment is indicated.
Clinical scenario
Active RRMS confirmed by clinical relapses and MRI brain activity — specifically contrast-enhancing lesions or new/unequivocally enlarging T2 lesions identified on brain MRI. This also applies to clinically isolated syndrome (CIS) meeting current MS diagnostic criteria.
Treatment approach
The approach centres on initiating a highly efficacious disease-modifying drug. Selection depends on several disease-specific and pharmacological factors that must be weighed carefully — the complete criteria and sequencing are detailed in the full protocol.
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.
- When treatment with a highly efficacious drug is stopped, either due to inefficacy or safety concerns, consider starting another highly efficacious drug.
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