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.
2023-12-23 01:51:33 - Editor
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:
- Test neutralizing antibodies [NAB] (high is abnormal) and MX1 Biological activity (low is abnormal)
- If NAB is <20, followup testing of NAB in 6 months
- 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:
- Switch to an interferon
- 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