Fast Five Quiz: Key Aspects of Multiple Sclerosis Treatment

Michelle H. Cameron, MD, PT, MCR; Kerstin Hellwig, MD


June 30, 2022

The American Academy of Neurology (AAN) and the European Committee of Treatment and Research in Multiple Sclerosis/European Academy of Neurology (ECTRIMS/EAN) advise that clinicians should counsel patients with MS who are considering discontinuing natalizumab because doing so is associated with an increased risk for relapse or MRI-detected disease activity within 6 months. Patients with MS who are taking natalizumab may choose to discontinue treatment with that drug owing to fear of risk for progressive multifocal leukoencephalopathy (PML) or for pregnancy planning.

Multiple studies of DMTs in patients with relapsing MS who have had recent relapse, MRI activity, or both have shown benefits from DMT treatment. This includes patients with a single clinical episode who meet the 2010 international criteria for MS. Clinicians should offer DMTs to patients with relapsing forms of MS with recent clinical relapse or MRI activity.

DMTs reduce MS relapses and MRI activity, but they do not eliminate them. Patients should be educated to ensure realistic expectations. DMTs are not indicated for relief of symptoms, so additional treatment may be required. Patients should also be counseled to notify clinicians if symptoms worsen.

DMTs have varying degrees of potential risk in pregnancy. Discussing the possibility of pregnancy with women with MS before initiating DMT is important. In general, women who have MS and are of childbearing potential should be advised that most DMTs are not licensed during pregnancy. For women who are planning to become pregnant soon, DMT decisions may be influenced by pregnancy plans.

Learn more about DMT in MS.


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