Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3 treatment practicalities and recommendations. MS Neurology Group of the Australian and New Zealand Association of Neurologists

Simon A Broadley; Michael H Barnett; Mike Boggild; Bruce J Brew; Helmut Butzkueven; Robert Heard; Suzanne Hodgkinson; Allan G Kermode; Jeannette Lechner-Scott; Richard A L Macdonell; Mark Marriott; Deborah F Mason; John Parratt; Stephen W Reddel; Cameron P Shaw; Mark Slee; Judith Spies; Bruce V Taylor; William M Carroll; Trevor J Kilpatrick; John King; Pamela A McCombe; John D Pollard; Ernest Willoughby; MS Neurology Group of the Australian and New Zealand Association of Neurologists

doi:10.1016/j.jocn.2014.01.017

Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3 treatment practicalities and recommendations. MS Neurology Group of the Australian and New Zealand Association of Neurologists

J Clin Neurosci. 2014 Nov;21(11):1857-65. doi: 10.1016/j.jocn.2014.01.017. Epub 2014 Jun 30.

Authors

Simon A Broadley¹, Michael H Barnett², Mike Boggild³, Bruce J Brew⁴, Helmut Butzkueven⁵, Robert Heard⁶, Suzanne Hodgkinson⁷, Allan G Kermode⁸, Jeannette Lechner-Scott⁹, Richard A L Macdonell¹⁰, Mark Marriott¹¹, Deborah F Mason¹², John Parratt¹³, Stephen W Reddel², Cameron P Shaw¹⁴, Mark Slee¹⁵, Judith Spies², Bruce V Taylor¹⁶, William M Carroll⁸, Trevor J Kilpatrick¹⁶, John King¹⁷, Pamela A McCombe¹⁸, John D Pollard², Ernest Willoughby¹⁹; MS Neurology Group of the Australian and New Zealand Association of Neurologists

Affiliations

¹ School of Medicine, Griffith University, Gold Coast Campus, QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia. Electronic address: [email protected].
² Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
³ Department of Neurology, The Townsville Hospital, Douglas, QLD, Australia.
⁴ Department of Neurology and St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia.
⁵ Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Department of Neurology, Eastern Health and Monash University, 2/5 Arnold Street, Box Hill VIC 3128, Australia.
⁶ Westmead Clinical School, University of Sydney, NSW, Australia.
⁷ South Western Sydney Clinical School, University of New South Wales, NSW, Australia.
⁸ Centre for Neuromuscular and Neurological Disorders, University of Western Australia, WA, Australia.
⁹ Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW, Australia.
¹⁰ Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
¹¹ Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
¹² Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
¹³ Central Clinical School, University of Sydney, NSW, Australia.
¹⁴ School of Medicine, Deakin University, VIC, Australia.
¹⁵ Flinders Medical Centre, Flinders University, SA, Australia.
¹⁶ Menzies Research Institute, University of Tasmania, TAS, Australia.
¹⁷ Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
¹⁸ University of Queensland Centre for Clinical Research, QLD, Australia.
¹⁹ Department of Neurology, Auckland City Hospital, Auckland, New Zealand.

PMID: 24993136
DOI: 10.1016/j.jocn.2014.01.017

Abstract

In this third and final part of our review of multiple sclerosis (MS) treatment we look at the practical day-to-day management issues that are likely to influence individual treatment decisions. Whilst efficacy is clearly of considerable importance, tolerability and the potential for adverse effects often play a significant role in informing individual patient decisions. Here we review the issues surrounding switching between therapies, and the evidence to assist guiding the choice of therapy to change to and when to change. We review the current level of evidence with regards to the management of women in their child-bearing years with regards to recommendations about treatment during pregnancy and whilst breast feeding. We provide a summary of recommended pre- and post-treatment monitoring for the available therapies and review the evidence with regards to the value of testing for antibodies which are known to be neutralising for some therapies. We review the occurrence of adverse events, both the more common and troublesome effects and those that are less common but have potentially much more serious outcomes. Ways of mitigating these risks and managing the more troublesome adverse effects are also reviewed. Finally, we make specific recommendations with regards to the treatment of MS. It is an exciting time in the world of MS neurology and the prospects for further advances in coming years are high.

Keywords: Evidence-based medicine; Guideline; Multiple sclerosis; Review; Treatment.

Publication types

Consensus Development Conference
Practice Guideline
Review

MeSH terms

Adult
Antibodies, Monoclonal, Humanized / adverse effects
Antibodies, Monoclonal, Humanized / immunology
Antibodies, Monoclonal, Humanized / therapeutic use
Australia / epidemiology
Disease Management
Disease Progression
Drug Monitoring
Drug Substitution
Drug-Related Side Effects and Adverse Reactions / etiology
Drug-Related Side Effects and Adverse Reactions / prevention & control
Evidence-Based Medicine
Female
Forecasting
Humans
Immunosuppressive Agents / adverse effects
Immunosuppressive Agents / therapeutic use*
Interferon-beta / immunology
Interferon-beta / therapeutic use
JC Virus / immunology
JC Virus / isolation & purification
Lactation
Leukoencephalopathy, Progressive Multifocal / prevention & control
Male
Multiple Sclerosis / drug therapy*
Multiple Sclerosis / epidemiology
Multiple Sclerosis / pathology
Multiple Sclerosis / therapy
Natalizumab
Neutralization Tests
New Zealand / epidemiology
Pregnancy
Pregnancy Complications / drug therapy
Therapies, Investigational / trends*
Treatment Outcome

Substances

Antibodies, Monoclonal, Humanized
Immunosuppressive Agents
Natalizumab
Interferon-beta