Structured Algorithm to Optimize Relapse Management in Multiple Sclerosis

The following article is part of conference coverage from the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers , in Seattle, Washington. MPR‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2019.

SEATTLE — Researchers at the 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 28 through June 1, 2019, in Seattle, Washington, presented an evidence- and clinical-based algorithm for managing multiple sclerosis (MS) relapses consisting of: 1) evaluating symptoms to distinguish pseudorelapse from actual MS relapse; 2) relapse treatment, if necessary; 3) assessment of response to treatment.

Acute clinical relapses, a defining feature of MS, have variable symptoms and potentially disabling outcomes. The available management options vary in terms of safety, efficacy, cost, and tolerability, however, no consensus statements exist to guide clinicians in approaching acute MS relapse. In an effort to develop a standardized and optimized approach to managing MS relapses, a group of MS clinicians combined a literature review of published on MS relapses with their own clinical experiences in managing MS relapse.

The clinician workgroup achieved a consensus and report a 3-step iterative management algorithm for MS relapses, as follows:

Step 1: Careful and timely evaluation of new symptoms.  Paramount in distinguishing relapse from pseudorelapse. Primarily a clinical evaluation, may not require imaging.

Step 2: Corticosteroid treatment is the mainstay of MS relapse management. Adrenocorticotropic hormone may be considered for patients who do not respond to or cannot tolerate corticosteroids. Plasma exchange therapy may be considered in cases of fulminant demyelination. Observation may be acceptable for mild cases.

Step 3: Clinical reassessment with the Assessing Relapse in Multiple Sclerosis Questionnaire recommended 3-5 weeks after initial evaluation. If symptoms worsen despite treatment, or a lack of functional recovery is found, relapse should be re-evaluated, and alternative treatment options should be considered.

Study investigators report financial connections to Acorda, Actelion, Adamas, Bayer HealthCare, Biogen, Clene Nanomedicine, Celgene, Covidien, EMD Serono, Genzyme, Genentech, Janssen, Medtronic, Nightstar, and ThromboGenics NV.

Visit MPR‘s conference section for continuous coverage from CMSC 2019.

Reference

Ross AP, Aburashed RA, Shin RK, et al. Optimizing multiple sclerosis relapse management: a structured approach. Presented at: The 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers; May 28-June 1, 2019; Seattle, WA. Abstract MOC04.

This article originally appeared on Neurology Advisor