Abstract Details

To approach MS effectively, recommendations, guidelines, and consensus are needed. Diagnosis, monitoring and disease treatment present several challenges. With numerous disease-modifying therapies (DMTs) available, and the lack of accurate biomarkers for predicting effectiveness and safety, therapeutic decision-making becomes challenging.

We aimed to provide a set of recommendations regarding comprehensive management of multiple sclerosis (MS) patients in Spanish clinical practice.

The Delphi methodology was used to develop the recommendations, which aimed to achieve consensus among experts based on their experience, the latest scientific evidence and the limitations of current resources. There were two rounds of evaluation, completed by 21 panelists who provided feedback on each item.

Nine dimensions of MS management are covered by the recommendations, including early diagnosis, early start of DMT, escalation versus early start of high-efficacy DMT, face-to-face and remote follow-up, suboptimal response detection, patient perspective, biomarkers and pregnancy, as well as vaccination. The panel recommends that the optic nerve lesions and a spinal MRI should be incorporated into the diagnosis to provide information to guide a therapeutic decision. Following diagnosis, the choice of initial treatment should not be based on the use of “treatment lines”, but primarily on the presence or absence of poor prognostic factors for the occurrence of relapses or disability progression. There are possibilities for telemedicine to supplement or replace some face-to-face follow-ups, but a face-to-face follow-up is recommended after starting the first DMT and in unstable patients. In women considering becoming pregnant, prior to pregnancy planning the patient should be stable and, if not, the treatment should be optimized.

This consensus provides recommendations for the comprehensive management of MS patients in Spanish clinical practice. It is expected that the recommendations will improve patient care and result in a higher quality of life for the patients.