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ACTRIMS 2022 | How to approach MS treatment sequencing in a crowded therapeutic market

Jeffrey A. Cohen, MD, Cleveland Clinic, Cleveland, OH, comments on how the treatment paradigm in multiple sclerosis (MS) has changed over recent years. It is now widely believed that early and aggressive treatment is beneficial, with many patients receiving newer, more efficacious drugs earlier in their disease course. However, there are still unaddressed questions regarding the best approach for long term outcomes. Ongoing trials are aiming to determine if starting with less potent agents and escalating as appropriate or starting with the most active agents from the beginning leads to better outcomes in the long run. This interview took place at the ACTRIMS Forum 2022 in West Palm Beach, Florida.

Transcript (edited for clarity)

I would say we’re still debating that. Over time, the trend in the field has been to use more efficacious drugs earlier in the sequence. And there’s probably less use of the original medications, the injectables, interferon-beta and glatiramer acetate. Although both of them still have a place, but I would say most clinicians over time are starting with somewhat more efficacious agents, right from the beginning, oral agents or the infusion monoclonal antibodies...

I would say we’re still debating that. Over time, the trend in the field has been to use more efficacious drugs earlier in the sequence. And there’s probably less use of the original medications, the injectables, interferon-beta and glatiramer acetate. Although both of them still have a place, but I would say most clinicians over time are starting with somewhat more efficacious agents, right from the beginning, oral agents or the infusion monoclonal antibodies. But I think that debate is still ongoing about in the long run, which approach is better? To start with a less potent agent first and escalate as needed, or to start right from the beginning with a highly efficacious agent. So the two ongoing randomized trials to address that specific question have not yet read out, but those data will be very important in how we manage multiple sclerosis.

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