The advent of new, highly effective therapies for MS has increased the likelihood of doctors responding to new symptoms by changing a person’s course of treatment. A recent study, based on medical records stored in the world’s largest MS clinical database, MSBase, showed that doctors are tolerating less and less disease activity and changing medications for MS at a higher rate than ever before. Data shows that neurologists are likely to change a person’s medication based solely on MRI data.

New medications give health professionals a variety of treatment options to choose from, allowing them to select the best therapy for each individual at a given time and thereby secure the best possible treatment outcomes. In the past, health professionals would only try a different medication in the event of a clinical relapse, but the proliferation of more effective treatment options has prompted neurologists to aim not only to stop relapses, but to stop MRI activity – a status known as ‘no evidence of disease activity’ (NEDA).

However, health professionals still face several challenges. Firstly, different individuals can respond to the same medication in different ways and there is no early warning system to predict this response. Whilst the growth in MS treatments has given health professionals unprecedented flexibility to switch medications, meanwhile, it can be difficult to determine precisely when to switch medications.

A group of international scientists have been examining the approach of MS neurologists to treating relapsing remitting MS and the level of disease activity at which they choose to change a person’s medication. The team examined 4,332 people with MS, looking at their MRIs and the treatment changes made in the event of a lesion being identified that didn’t lead to any symptoms – so called “silent lesions”.

Role of MRI

The results, recently published in the Multiple Sclerosis Journal, show that treatment management in relapsing remitting MS relies heavily on MRI monitoring and that, in around 26 per cent of cases, the identification of just one new T2 lesion in the brain that did not cause a symptom prompted a change in treatment. This figure increased to 50 per cent among people with more than 6 new T2 lesions on the brain. T2 lesions are generally considered to be older and less active lesions. Participants with a more active or T1 lesion, meanwhile, were twice as likely to have their medication switched compared to those with a T2 lesion. The results also show that participants taking an older type of medication, such as an injectable medication, were more likely to have their medication changed if MRI detected a silent brain lesion.

It is important to note that, in countries without affordable access to all available MS medications, it may be more difficult to switch medications.

Overall, this study shows that MS specialists are increasingly relying on MRI alone to make treatment decisions, and that they are tolerating less and less disease activity, to the extent that they will even switch people’s medication if there is one silent lesion in the brain. This highlights the importance of MRI in treatment decisions and the need for regular scans, even in the absence of new symptoms. The results clearly demonstrate the changes in clinical management of MS, and that the availability of newer, highly effective medications has allowed the goalposts to shift in this very dynamic treatment landscape. This is likely to have a huge positive effect on the long-term outcomes of people with relapsing remitting MS.

With thanks to MS Research Australia – the lead provider of research summaries on our website.

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