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Background/Objectives: Multiple Sclerosis (MS) is a chronic disease with significant clinical and radiological heterogeneity. This fact, together with the increased number of disease-modifying treatments available, poses challenges in the therapeutic decisions and for the overall management of the disease. In this study, an expert panel on MS from Greece aimed to formulate a consensus, in order to provide recommendation on disease-modifying treatment (DMT) initiation and switching, as well as de-escalation strategies in Relapsing MS (RMS). Methods: The study followed two-round voting based on a modified Delphi setting. A questionnaire was constructed by a subgroup of five experts (core group) and was subsequently administered in a printed form to a group of 12 MS experts in total (panel) in a face-to-face meeting. Consensus required at least 80% agreement within the panel in order to signify strong consensus. Results: The panel agreed that the overall therapeutic plan (DMT choice) must take into consideration the degree of disease activity (low/moderate/high). In certain cases with suboptimal response to a moderate-efficacy DMT, a horizontal switch to another moderate-efficacy DMT may be a valid strategy. However, in cases exhibiting disability accumulation, therapy escalation should be preferred. The concept of de-escalation was suggested as an alternative strategy for cases with stable disease receiving a high-efficacy long-term DMT in the long term. Due to the possibility of rebound phenomena with certain medications (such as fingolimod and natalizumab), a bridging strategy could be applied in cases of family planning and drug-related adverse events (such as lymphopenia and hepatotoxicity), especially in PwMS with recent inflammatory activity. Conclusions: Although novel biomarkers may soon help clinicians predict future disability accumulation, currently, regular and detailed patient monitoring seems to be the optimal way to guide clinicians’ decisions on treatment changes.
Boziki et al. (Fri,) studied this question.