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Abstract Details

Approach to Balancing Risk in Multiple Sclerosis Management: a Worldwide Practice Survey
Multiple Sclerosis
P14 - Poster Session 14 (11:45 AM-12:45 PM)
3-013
Available disease-modifying therapies (DMTs) for MS are rapidly expanding; this coincides with debate surrounding DMT selection and treatment strategies. Although escalation approaches have been previously favored to balance safety and efficacy, emerging evidence suggests superior outcomes for MS patients who are exposed to high-efficacy therapies early on. Additionally, there is growing controversy regarding use of gadolinium-based contrast agents in routine monitoring due to risk of gadolinium deposition. 

To explore practice differences in prevailing treatment strategies of multiple sclerosis.

We used a worldwide electronic survey launched by the Practice Current section of Neurology® Clinical Practice. Practice-related questions pertained to a case of a 37-year-old female presenting with unilateral optic neuritis alongside non-enhancing lesions in the cerebellum and spinal cord. Respondents were asked to indicate their initial investigations, relapse-management strategy, choice of disease modifying therapy, and plan for follow-up imaging (contrast/non-contrast). Multivariable analysis was precluded by low response numbers.      
We received 153 responses from 42 countries; 32.3% identified as MS specialists. There was a strong preference for intravenous (rather than oral) delivery of high-dose corticosteroids (87.7% vs. 8.0%) and 61.3% indicated they would treat a non-disabling (mild sensory) MS relapse. Given the described clinical scenario, 59.4% felt the patient was at risk of a severe MS course. When asked to select a single initial DMT, 55.8% selected a high-efficacy therapy (67.5% MS specialists vs. 52.4% non-MS specialists). The most selected agents overall were fingolimod (14.7%), natalizumab (15.5%) and dimethyl fumarate (20.9%). Two-thirds of respondents (69.2%) indicated they would request contrast enhanced (vs. non-enhanced) MRI for follow-up imaging (61.9% MS specialists vs. 70.1% non-MS specialists).  

Although there is a slight preference for initiating high-efficacy DMT at the time of initial MS diagnosis, opinions regarding the most appropriate treatment paradigm remain divided.  

Authors/Disclosures
Jodie Roberts, MD
PRESENTER
An immediate family member of Dr. Roberts has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylyx Pharmaceuticals. Dr. Roberts has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Roberts has received research support from Canadian Network of MS Clinics. Dr. Roberts has received research support from Rebecca Hotchkiss International Exchange Program. The institution of Dr. Roberts has received research support from University of Calgary Medical Group Helios Award. Dr. Roberts has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Novartis. Dr. Roberts has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with EMD Serono.
Aravind Ganesh (University of Calgary) No disclosure on file
Luca Bartolini, MD, FAAN (Meyer Children's Hospital) Dr. Bartolini has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology.
Tomas Kalincik Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi Genzyme. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Tomas Kalincik has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Health and Medical Research Council. Tomas Kalincik has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MS Research Australia. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Tomas Kalincik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Tomas Kalincik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for WebMD Global. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi Genzyme. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for BioCSL. Tomas Kalincik has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck. Tomas Kalincik has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. The institution of Tomas Kalincik has received research support from Biogen. The institution of Tomas Kalincik has received research support from Novartis. The institution of Tomas Kalincik has received research support from Genzyme. The institution of Tomas Kalincik has received research support from Roche. The institution of Tomas Kalincik has received research support from Celgene. The institution of Tomas Kalincik has received research support from Merck. The institution of Tomas Kalincik has received research support from MSBase Foundation. The institution of Tomas Kalincik has received research support from ARSEP and EDMUS Foundations. The institution of Tomas Kalincik has received research support from MS Research Australia. The institution of Tomas Kalincik has received research support from National Health and Medical Research Council. The institution of Tomas Kalincik has received research support from Australian Research Council. The institution of Tomas Kalincik has received research support from MS Society. The institution of Tomas Kalincik has received research support from Trish Foundation. Tomas Kalincik has a non-compensated relationship as a scientific leadership group vice-chair with MSBase Foundation that is relevant to AAN interests or activities.