"Clinical Challenges: Aggressive Or Cautious When Treating Relapsing MS?" - Kristina Fiore
The central question when starting treatment for a newly diagnosed relapsing remitting multiple sclerosis (RRMS) patient is essentially this: do you come out swinging, or do you take a more step-wise approach? With 15 disease-modifying therapies available – ranging in impact from the old staple of interferon injections to more potent oral drugs and powerful infusion therapies, to chemotherapy-like alemtuzumab – the choice isn't an easy one. Add to that the heterogeneity of the condition itself, with each patient being different from the last, and the picture is extremely complicated. Stephen Krieger, MD, an associate professor of neurology at the Icahn School of Medicine at Mount Sinai, said he prefers an escalation strategy, with a caveat, "it's escalation, but it's not complacent." For instance, he talks to patients about the injectable like interferon and glatiramer acetate and then about oral medications. Dr. Krieger said it's rare that he would use an infusion therapy as a first-line agent.
- Stephen Krieger, MD, Associate Professor, Neurology, Icahn School of Medicine at Mount Sinai