9.5. MS Coalition-Disease Modifying Therapy
Please see the attached MS Coalition Disease Modifying Therapy paper. And, visit MS Coalition for more details.
3 University Plaza Drive, Suite 116
Hackensack, NJ 07601
Fax: (862) 772-7275
The National MS Society and the other member organizations of the MS Coalition have collaborated to produce a consensus document to summarize current evidence about disease modification and provide support for broad access to FDA-approved DMTs. This evidence-based document may be useful when addressing insurance questions (preauthorization, formulary, etc.); a companion piece for general audiences is currently under development.
Initiation of treatment with an FDA-approved DMT is recommended:
- As soon as possible following a diagnosis of relapsing MS
- For individuals with a first clinical event and MRI features consistent with MS, where other possible causes have been excluded
- For individuals with secondary-progressive multiple sclerosis who continue to demonstrate clinical relapses and/or demonstrate inflammatory changes
Treatment with any given DMT should be continued indefinitely unless any of the following occur:
- Sub-optimal treatment response as determined by the individual and the clinician
- Intolerable side effects or inadequate adherence
- Availability of a more appropriate treatment
The factors affecting choice of treatment are complex and most appropriately addressed by the individual in collaboration with the treating clinician. Movement from one DMT to another should occur only for medically appropriate reasons.
Due to significant variability in the MS population, people with MS and their clinicians require full access to a range of treatment options:
- Different mechanisms of action allow for treatment change in the event of sub-optimal response.
- Potential contraindications limit options for some individuals
- Risk tolerance varies among people with MS and their clinicians
- Route of delivery and side effects may affect adherence
- Individual differences related to tolerability and adherence may necessitate access to different medications within the same class
Access to treatment should not be limited by the patient's frequency of relapses, level of disability, age, gender or ethnicity. Absence of relapses while on treatment should not be considered a justification for discontinuation of treatment. Treatment should not be discontinued to allow for determination of coverage by payers.