ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis

Abstract

Background and purpose: Multiple sclerosis (MS) is a complex disease with new drugs becoming available in the past years. There is therefore a need for a reference tool compiling current data to aid professionals in treatment decisions. The objective was to develop an evidence-based clinical practice guideline for the pharmacological treatment of people with MS. Methods: This guideline has been developed using the GRADE methodology and following the updated EAN recommendations for guideline development. Clinical questions were formulated in PICO format (patient, intervention, comparator, outcome) and outcomes were prioritized according to their relevance to clinical practice. Literature searches up to December 2016 were performed and the evidence is presented narratively and, when possible, combined in a fax: +34 93 2746084; e-mail: xavier.montalban@cem-cat.org) and for EAN: R. Gold, Department of Neurology, Ruhr University, St Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany (tel.: +49-234-509244; fax: +49-234-5092414; e-mail: ralf.gold@rub.de). This is a Continuing Medical Education article, and can be found with corresponding questions on the EAN website, LEARN section https://www.ean. org/CME.2714.0.html. Certificates for correctly answered questions will be issued by EAN directly, you simply have to be logged-in. With positive results, EAN recommends accreditation of 1 hour of CME, which may be claimed with the national body in charge of CME accreditation. This paper is being simultaneously published in European Journal of Neurology and Multiple Sclerosis Journal.[Correction added on 13 February 2018, after online and print publication: (a) The abstract has been updated and a conclusion section in now included; (b) Recommendation 4 and 7 has been amended, and an additional recommendation has been added after the latter]. meta-analysis. The quality of evidence was rated into four categories -very high, high, low and very low À according to the risk of bias. The recommendations with assigned strength (strong, weak) were formulated based on the quality of evidence and the riskÀbenefit balance. Consensus between the panelists was reached by use of the modified nominal group technique. Results: A total of 10 questions have been agreed, encompassing treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and treatment strategies in MS and pregnancy. The guideline takes into account all disease-modifying drugs approved by the European Medicine Agency at the time of publication. A total of 21 recommendations were agreed by the guideline working group members after three rounds of consensus. Conclusion: The present guideline, which includes descriptions of the evidence together with recommendations, will enable homogeneity of treatment decisions across Europe. © 2018 European Academy of Neurology and European Committee of Treatment of Research in Multiple SclerosisBackground and scope

Early versus later treatment start in multiple sclerosis: a register‐based cohort study

“…Our study assessed the effectiveness of treatment with DMT using real‐world data from MS registries in Denmark and is the first nationwide population‐based study to show a beneficial effect of early treatment versus later treatment with DMT. The recently published American (American Academy of Neurology) and European (European Committee for Treatment and Research in Multiple Sclerosis/European Academy of Neurology) treatment guidelines agree that patients with MS should be offered treatment as early as possible. Data from the Danish MS registries indicate that treatment with DMT in general is started early after the MS diagnosis in Denmark (83.4% of patients who started treatment early after clinical onset and 61.3% who started treatment later had started treatment within 1 year after their MS diagnosis) (Table S1).…”

Disease-modifying therapies for multiple sclerosis

“…This is the first episode of neurological symptoms suggestive of multiple sclerosis with brain MRI abnormalities (indicating a high risk of multiple sclerosis). The aim of treatment is to delay a second attack 89…”

“…International guidelines recommend offering DMTs to patients with active relapsing multiple sclerosis (table 1). 789…”

The efficacy and safety of fingolimod in patients with relapsing multiple sclerosis: A meta‐analysis

“…Multiple sclerosis (MS) is a chronic disease that affects the central nervous system and is characterized by inflammation, demyelination and degenerative changes . Relapsing–remitting MS (RRMS) is the most common disease course and characterized by clearly defined attacks of new or increasing neurological symptoms.…”