This protocol addresses patients with a relapsing form of multiple sclerosis who cannot access the approved disease-modifying therapies (DMTs) that would ordinarily be prescribed. In these circumstances, evidence-based alternative options remain available and should be considered.
The patient has relapsing MS — a course characterised by discrete episodes of neurological deterioration — but approved DMTs are inaccessible due to availability constraints. This scenario requires selecting from agents that have demonstrated benefit in this population despite not being the standard approved options.
Current guidance supports recommending specific alternative agents for this population. At least one recommended option is available only in a parenteral formulation. The complete protocol — including the full set of options and their relevant clinical considerations — is accessible via the link below.
DOI: 10.1212/WNL.0000000000005347
Clinicians may recommend azathioprine or cladribine for people with relapsing forms of MS who do not have access to approved DMTs (Level C).
Cladribine has evidence of benefit for both the oral and parenteral formulations, but currently only the parenteral formulations are available.
View source ↗