Optimizing outcomes in multiple sclerosis - A consensus initiative

Background: Initiation of immunomodulators in patients experiencing a clinically isolated syndrome (CIS) may delay progression to clinically definite MS. However, lack of consensus remains on many issues affecting optimal management of MS. Method: A panel of 21 MS experts met during 9 meetings to explore key issues in MS and CIS. Meetings addressed 3 phases: 1. CIS definition and diagnosis; 2. initial therapy; and 3. monitoring disease progression and treatment efficacy. Newsletters covering each phase were sent to 5000 U.S.-based neurologists who were invited to participate in an online survey on key issues. Results: Most panel members agreed that early treatment may minimize neurodegeneration and most would recommend it for patients; that a dose-response relationship exists for beta-interferon therapy; that more aggressive therapy was most effective early in the disease course; and, that MRI has a role in monitoring disease progression. In face of suboptimal response, most would switch patients to a different therapy; while combination therapy would be reserved for those failing monotherapy regimes. Most online survey respondents agreed with these positions. Conclusions: There was uniform consensus from this panel of MS experts that early initiation of immunomodulator therapy was beneficial for CIS patients.