Fast Five Quiz: Managing Progression of Relapsing-Remitting Multiple Sclerosis

Christopher Luzzio, MD; Kerstin Hellwig, MD


July 01, 2022

Changing to another MS drug of a different mechanism of action is appropriate for patients who demonstrate new inflammatory changes on MRI studies or have clinical evidence of disease progression. Breakthrough disease activity while on therapy should prompt an evaluation of possible suboptimal response. When disease activity is significant, the recommended strategy is to advance to a higher-efficacy agent unless safety factors or contraindications preclude their use.

A regimented stepwise approach to therapy (ie, initiation with an injectable agent with escalation to a higher-efficacy agent if there is a breakthrough in disease activity) is generally not recommended for patients with MS. Instead, selecting a DMT should begin with a discussion of which administration mode is most amenable to the patient. Clinical experience has demonstrated that patients should be placed on the optimal DMT on the basis of individual needs rather than on escalation alone. Studies are ongoing to evaluate escalation (early low-efficacy drugs) vs de-escalation (early high-efficacy drugs) in planning initial and long-term treatment.

Patients with MS who are well controlled on injectable drugs but switch to oral therapies are not at greater risk for early relapse.

MRI findings are critical in detecting early breakthrough disease activity and may accurately predict how the patient will respond following a switch.

Learn more about DMTs.


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