Right therapy, right patient, right time

From the time of diagnosis onwards, multiple factors impact on treatment selection.

Initial choice of treatment is founded on the efficacy, safety and tolerability of a DMT, given the patient’s profile. Patients may subsequently need to switch treatments because of:1,2

  • Changes in disease activity
  • Suboptimal responses
  • Safety concerns
  • Intolerable side effects / tolerability issues / change in risk tolerance
  • Change in quality of life / or lifestyle, including pregnancy planning

Keep options open and think ahead

“Like a good chess player who thinks several moves ahead, performing multiple benefit–risk assessments across several DMTs ...is required when reviewing medication at any point in time”

Pardo & Jones 2017 1

A central principle of treatment sequencing is to keep subsequent treatment options open – and this requires thinking several moves ahead.1

Current opinion is that in the management of RRMS, treatment sequencing should be considered: 1-3

  • Early in the course of disease AND when reviewing medication at any time point
  • In order to keep alternative therapeutic options available for later-line therapy

MultiplechoiceS: Treatment sequencing

Treatment sequencing is an important and emerging concept in RRMS management1,2. It acknowledges both the heterogeneity of RRMS and the fact that as a chronic, progressive and as-yet incurable disease, patients with RRMS may need different DMTs at different times over their lifetime.

The challenge for healthcare professionals is planning the best order in which to use the available DMTs in any given patient.

Video Resources

Dr Matt Craner shares his views on right treatment, right patient, right choice

Dr Matt Craner is a consultant neurologist at Frimley Park Hospital, and clinical lead for the MS Trials Unit at the Nuffield Department of Clinical Neurosciences in Oxford

Immunology Foundations Part 1

Dr Matt Craner
Consultant neurologist

Immunology Foundations Part 2

Joela Mathews
Lead Neuropharmacist

Advanced Immunology Part 1

Joela Mathews
Lead Neuropharmacist

Advanced Immunology Part 2

Joela Mathews
Lead Neuropharmacist

Advanced Immunology Part 3

Sarah White
MS Clinical Nurse Specialist

Use of Medicines

Sarah White
MS Clinical Nurse Specialist

Sources and further reading

  1. Pardo G & Jones E. J Neurol 2017;264(12):2351-74.
  2. Grand'Maison F, et al. Curr Med Res Opin; 34(8):1419-30.
  3. Scolding N, et al. Pract Neurol. 2015;15(4):273-279.

Biogen-25454     Date of prep: November 2019