b'Life with MSWWhhaattDDooeesstthheeMMSSCCrryyssttaallBBaallllSShhooww??The future of MS management looks brightBy Dr. Ben Thrower, M.D.OneofmyfavoriteactivitiesintheMS norelapses,noprogressionofdisability,andworldisteaching.WhetherImworkingwith nonewMRIlesions.students,otherhealthcareproviders,ortheMS Lets startwith escalation therapy.Thiscommunity,Ilovebringingnewinformation paradigmwouldargueforstartingMStherapytoaneageraudience.Therewasatime,onlya withadrugthathasgreatsafetyandreasonablefewdecadesago,whenthoselecturesfocused eectiveness.MostofouroriginalMStherapiesonthepathologyanddiagnosisofMS.The likebetainterferonsandglatirameracetateportionsontreatingMSwereprettybrief.We wouldtintothiscategory.Withluck,thecurrentlyhave20FDA-approvedtherapiesto personwithMSachievesNEDAwiththeirhelpmanageMS,butnotalloftheadvances therapy.Iftheydont,thenwemovetoamoreinvolvemedications.Letstakealookatsome effectivedrugthatmayalsohavemorebig picture concepts of where things are potentialrisk.ThemajordisadvantagetothisheadedinthemanagementofMS. approachisthatthepersonwithMScouldWhenwethinkaboutthose20FDA-approved accumulatenewpermanentdisabilitybeforetreatmentoptions,howdowegoaboutpicking theyaremovedtoamoreeectivetherapy.one?Therearetwoparadigmsouttherethat Withinductiontherapy,wechooseamoreserveasguidesforchoosingamedication. eective treatment option from the start.Thesearereferredtoasescalationtherapy Theseoptionsmaycarryhigherriskalongandinductiontherapy.Allofourtreatment withtheirhighereectiveness.Itseemsthatoptionscanbegivenagradebaseduponhow manyMScenters,includingours,aremovingconvenienttheyare,howeectivetheyare, towardsthisparadigm.Medicationssuchasandhowsafetheyare.IwilladdthatMS natalizumabandocrelizumabaregenerallyhealthcareprovidersdontalwayscompletely moreeectiveinrelapsingformsofMSandagreeonhowtheywouldrankthedrugsin mayoerthebestchanceofpreventinganyeachofthesecategories.Weshouldalsoclarify diseaseprogression.Ofcourse,theriskofwhatweexpectfromanMStherapy.Ideally, thesemoreeectivetherapiesneedstobewewillachieveNEDA(NoEvidenceofDisease discussedatlengthwiththepersonwithMSActivity)withanMStherapy.NEDAmeans andtheirfamily.msfocusmagazine.org 34'