Highlights
- •No recommendations are available on switching disease-modifying treatments in multiple sclerosis
- •The French Multiple Sclerosis Society proposes guidelines on this important and practical topic
Abstract
Background
Today, there are no recommendations on switching disease-modifying treatments (DMTs)
in multiple sclerosis (MS).
Objectives
To establish guidelines on switching DMTs MS.
Methods
A Steering Committee composed of seven MS experts from the French Group for Recommendations
in Multiple Sclerosis (France4MS) defined 15 proposals. These proposals were then
submitted to a Rating Group, composed of 48 French MS experts, for evaluation. The
proposals were classified as ‘appropriate’, ‘inappropriate’ or ‘uncertain’.
Results
Switching from a first-line therapy to another first-line therapy or a second-line
therapy could be done without a washout period. Switching from a second-line therapy
to a first-line therapy could be done without a washout period with fingolimod or
natalizumab, after 3 months with ocrelizumab or mitoxantrone, and, if disease activity
occurs with alemtuzumab or cladribine. The switch from a second-line therapy to another
second-line therapy could be done after a washout period of 1 month with fingolimod
or natalizumab, after 3 months with ocrelizumab, after 6 months with mitoxantrone,
and, if disease activity occurs, with alemtuzumab or cladribine.
Conclusion
This expert consensus approach provides physicians with some guidelines on optimizing
the benefit/risk ratio when switching DMTs in patients with MS.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: June 10, 2021
Accepted:
June 2,
2021
Received in revised form:
May 25,
2021
Received:
March 15,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
