Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies

Robert H. Gross, MD; John R. Corboy, MD, FAAN p. 715-735 June 2019, Vol.25, No.3 doi: 10.1212/CON.0000000000000738
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PURPOSE OF REVIEW: This article reviews appropriate monitoring of the various multiple sclerosis (MS) disease-modifying therapies, summarizes the reasons patients switch or stop treatment, and provides a framework for making these management decisions.

RECENT FINDINGS: With the increasing number of highly effective immunotherapies available for MS, the possibility of better control of the disease has increased, but with it, the potential for side effects has rendered treatment decisions more complicated. Starting treatment early with more effective and better-tolerated disease-modifying therapies reduces the likelihood of switching because of breakthrough disease or lack of compliance. Clinical and radiographic surveillance, and often blood and other paraclinical tests, should be performed periodically, depending on the disease-modifying therapy. Helping patients navigate the uncertainty around switching or stopping treatment, either temporarily or permanently, is one of the most important things we do as providers of MS care.

SUMMARY: Ongoing monitoring of drug therapy is a crucial component of long-term MS care. Switching treatments may be necessary for a variety of reasons. Permanent discontinuation of treatment may be appropriate for some patients with MS, although more study is needed in this area.

Address correspondence to Dr Robert H. Gross, Anschutz Outpatient Pavilion, Mail Stop F727, 1635 Aurora Ct, 5th Floor, Aurora, CO 80045,

RELATIONSHIP DISCLOSURE: Dr Gross reports no disclosure. Dr Corboy serves as editor of Neurology Clinical Practice, as a consultant for a legal matter for Mylan NV, and on the research steering committee for Novartis AG. Dr Corboy has received personal compensation for speaking engagements from PRIME Education, LLC, and the Rocky Mountain Multiple Sclerosis Center and receives research/grant support from MedDay Pharmaceuticals, the National Multiple Sclerosis Society, Novartis AG, and the Patient-Centered Outcomes Research Institute. Dr Corboy has served as a consultant on medicolegal proceedings for medical malpractice.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Gross and Corboy discuss the unlabeled/investigational use of cyclophosphamide and rituximab for the treatment of multiple sclerosis.

© 2019 American Academy of Neurology.