Los Angeles—Earlier is better when it comes to treating multiple sclerosis (MS), according to new guidelines from the American Academy of Neurology (AAN).

The document, presented at the recent 70th AAN Annual Meeting in Los Angeles and published in the journal Neurology, points out that several MS drugs have either strong or moderate evidence supporting their use for slowing certain disease processes.

The Multiple Sclerosis Association of America and the National Multiple Sclerosis Society endorse the guideline.

“The treatment landscape for people with MS has changed dramatically over the last decade,” explained lead author Alexander D. Rae-Grant, MD, of Cleveland Clinic in Cleveland, Ohio. “We now have a number of disease-modifying therapies to choose from that may help treat MS by changing how the disease affects people over time by slowing the disease process.”

Although not a cure, disease-modifying therapies (DMT) can do more than just manage symptoms; they also can alter or change the course of MS for patients, the article adds.

Overall, guideline panelists made 17 initiation, 10 switching, and three stopping recommendations. Included were recommendations on who should start a DMT, including patients with relapsing-remitting MS (RRMS), as well as those with a single clinical demyelinating event and two or more brain lesions characteristic of MS patients who decide they want to take DMTs.

Advice on switching agents when breakthrough disease occurs was included, as was information on DMT risks, including counseling about progressive multifocal leukoencephalopathy risk in MS patients taking natalizumab, fingolimod, rituximab, ocrelizumab, and dimethyl fumarate.

Specifically, the following recommendations were made:

• In patients with RRMS, many DMTs are superior to placebo as measured by annualized relapses rates (ARRs), new disease activity as measured by new MRI T2 lesion burden, and in-study disease progression.
• For patients with RRMS who experienced a relapse while using interferon beta or glatiramer acetate, alemtuzumab is more effective in reducing the ARR than interferon beta-1a 44 mcg SC three times per week.
• For patients with primary progressive MS, ocrelizumab is probably more effective than placebo as measured by in-study disease progression. DMTs for MS have varying adverse effects.
• In patients with clinically isolated syndrome, glatiramer acetate and interferon beta-1a SC three times per week are more effective than placebo in decreasing the risk of conversion to MS. Cladribine, immunoglobulins, interferon beta-1a 30 mcg IM weekly, interferon beta-1b SC alternate-day, and teriflunomide are probably more effective than placebo in decreasing the risk of conversion to MS.

Panelists also outlined priorities for future research, including higher-potency treatment initially versus standard stepped-care protocols, longer-term studies, studies focused on patient-centered outcomes, comparative-effectiveness studies, better definitions of highly active MS, and studies of various switching strategies.