multiple sclerosis management

Navigate the intricacies of Multiple Sclerosis Disease-Modifying Therapy with this in-depth follow-up protocol guide. Learn about crucial testing, including neutralizing antibodies and MX1 biological activity, for patients on interferons or Copaxone.

MULTIPLE SCLEROSIS DISEASE MODIFYING THERAPY

Once therapy is initiated, this is the protocol for followup:

At 12 months, or if there is breakthrough disease:If the patient is on interferons:

1. Test neutralizing antibodies [NAB] (high is abnormal) and MX1 Biological activity (low is abnormal)
2. If NAB is <20, followup testing of NAB in 6 months
3. If NAB is >20, switch to a different med if symptomatic. But if asymptomatic repeat in 6 months. If again positive, switch.

If the patient is on Copaxone:

1. Switch to an interferon
2. Using Disease Activity for decision making:

High disease activity:

       Switch medication regardless of antibodies

Intermediate disease activity:

       Use NAB and MX1 to make a decision. If antibodies abnormal, switch medications

Low disease activity:

       Switch only if antibodies consistently positive 6 months apart

Remember, antibodies should be tested only after at least 30 days have passed since the last steroid therapy.

Second tier medications:

Fingolimod

Natalizumab

Third tier:

Mitoxantrone

Last resort:

Rituximab