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Sequencing of high-efficacy disease-modifying treatments in MS

AAN 2019
Given the chronic nature of MS and sub-optimal treatment response occurring frequently, sequencing of multiple treatments has become routine practice. The aim is to maximise the benefit–risk balance of treatment. One of the reasons this poses a challenge, is that real-world evidence for the numerous possible strategies is scarce. A number of studies on this subject were presented at the AAN 2019 meeting: A real-world study looked at discontinuation and effectiveness of dimethyl fumarate (n=428) and fingolimod (n=358) over 36 months in 786 MS patients [1]. More patients on dimethyl fumarate discontinued than on fingolimod (58.3% vs 45.2%; OR 1.81; P<0.001). The main cause was intolerance. Within 12 months of discontinuation, one third of patients had switched to high efficacy therapy (natalizumab, rituximab, ocrelizumab, alemtuzumab), while 39-48% switched to a first-line injectable or oral disease-modifying treatment. After switching to hig...

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