title: Utility of the Canadian Treatment Optimization Recommendations (TOR) in MS care.
abstract: OBJECTIVE
  Criteria for Treatment Optimization Recommendations (TOR) for patients with multiple sclerosis (MS) identify suboptimal response to disease-modifying treatment (DMT). The Canadian TOR (CanTOR) were used to indicate recommendations for treatment switches or treatment maintenance based on relapse, disease progression and magnetic resonance imaging (MRI) criteria in patients. We assessed concordance between the TOR and clinicians' decisions regarding treatment response and identified prevalence of patients with MS receiving DMT meeting medium/high levels of concern according to TOR.
  
  
  METHODS
  Prospective baseline and end-of-study assessments of patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome were conducted in this open-label, 12-month, Phase IV, observational Canadian study.
  
  
  RESULTS
  Data were reported for 184 patients (female 72%, mean age 39 years) of which 96% had RRMS. The TOR criteria identified 19 (10.3%) patients with suboptimal response to treatment. Twelve patients had ≥1 high level of concern. Two patients had ≥2 medium levels of concern. Concordance between TOR and clinician decision in maintaining treatment was 95.3%. Where treatment change was recommended by the TOR, concordance was 29.4%. Clinicians identified the TOR as the principal reason for changing treatment in 50.0% of cases where the TOR identified suboptimal response. The TOR were considered useful by 70.6% of clinicians when treatment optimization was recommended and by 55.3% when maintaining treatment was recommended.
  
  
  CONCLUSIONS
  The TOR criteria can identify suboptimal response in this patient cohort. Concordance between TOR and clinician decision was high when maintaining treatment was recommended. Usefulness of the TOR was most apparent when treatment optimization was recommended.
authors.affiliation: Department of Medicine (Neurology), University of Sherbrooke, Hôpital Charles LeMoyne, Greenfield Park, Quebec, Canada. fgrandm@videotron.ca
authors.forename: François
authors.initials: F
authors.lastname: Grand'Maison
authors.forename: Virender
authors.initials: V
authors.lastname: Bhan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Freedman
authors.forename: Mary L
authors.initials: ML
authors.lastname: Myles
authors.forename: David G
authors.initials: DG
authors.lastname: Patry
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Selchen
authors.forename: Patrick
authors.initials: P
authors.lastname: Moriarty
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Traboulsee
mesh_terms: D000328:Adult; D002170:Canada; D003711:Demyelinating Diseases / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D007155:Immunologic Factors