New AAN Guideline: Patients With Multiple Sclerosis Should Start Treatment Early


The American Academy of Neurology (AAN) has released a new guideline for treating patients with multiple sclerosis (MS), which is endorsed by both the National Multiple Sclerosis Society and the Multiple Sclerosis Association of America. This is the first new guideline for MS treatment in over a decade (Neurology:Published online April 23, 2018).

Among the most significant recommendations are that patients with MS should begin taking disease-modifying treatment (DMT) as early as possible, and that several DMTs have strong or moderate evidence supporting use to slow the progression of MS.  The guideline notes that although clinically significant symptoms may be stopped by treatment, that does not mean that disease progression has stopped.  As a result, there are few studies regarding the effect of stopping treatment and thus no evidence of benefit for stopping or continuing DMT. However, there is evidence that when the disease progresses despite a patient taking a DMT, they may need to switch to a different DMT shown to have less occurrence of relapse.

Through literature review and consensus decision making, the authors of the guideline made a total of 30 specific recommendations related to initiating, switching, and stopping pharmacologic therapies, and to weighing risks and benefits of treatment including reproductive effects of DMT.

“The treatment landscape for people with MS has changed dramatically over the last decade,” said lead author Alexander D. Rae-Grant, MD, FAAN, of Cleveland Clinic in Cleveland, Ohio, and a Fellow of the American Academy of Neurology. “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


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