title: Overview of the management of relapsing-remitting multiple sclerosis and practical recommendations.
abstract: The initial phases of the clinical course of relapsing-remitting multiple sclerosis (MS) are characterized by a mainly inflammatory pathology which gives way to a largely neurodegenerative process as the disease evolves. As all currently available disease-modifying therapies aim to control inflammation, the window of opportunity for use is early in the disease course, specifically at the time of a clinically isolated syndrome suggestive of MS or in the early stages of relapsing-remitting MS. Approximately 30% of patients treated with first-line immunomodulators (interferon-β or glatiramer acetate) show a suboptimal response during the first 1-2 years and require a switch to an alternative therapy. It is recommended not to wait too long to switch in order to prevent disease progression. Patients with a poor prognosis in particular may require a timely switch to a second-line agent. Regular monitoring of disease and therapy in patients with MS is essential. In the first year after diagnosis, clinical evaluations (neurological status, symptomatic assessment, patient well-being) should be performed at baseline, 3, 6 and 12 months, and then every 6 months thereafter. Brain magnetic resonance imaging (MRI) should be performed every 6 months in the first year of treatment, and at least once yearly thereafter. A spinal cord MRI should be performed once yearly in patients presenting spinal symptoms.
authors.affiliation: Department of Neurosciences, Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gallo
authors.affiliation: Rehabilitation and MS-Centre Overpelt and Biomedical Institute, University Hasselt, Hasselt, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Van Wijmeersch
mesh_terms: D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*
chemical_list: D007155:Immunologic Factors
keywords: disease-modifying therapy; escalation; glatiramer acetate; interferon-beta; multiple sclerosis, propensity score; relapsing−remitting; switching