Review of the Clinical Debate Regarding Interventions for Multiple Sclerosis

BACKGROUND: Multiple sclerosis (MS) is a debilitating and progressive neurologic disorder characterized by relapses and neurological deterioration. The mainstay of treatment for MS are the disease-modifying therapies (DMTs), which are costly biologic agents designed to reduce the rate of relapse and progression of the disease. Despite the presence of several approved medications and a substantial amount of experience with these agents, various uncertainties remain regarding the optimal management of MS. Issues that are frequently debated include when to start therapy, which agent to use, how to improve adherence to DMT, and issues related to long-term use of DMTs. OBJECTIVE: To familiarize managed health care professionals with current issues and ongoing challenges in the management of MS, and to consider potential strategies to overcome these challenges and optimize treatment outcomes. SUMMARY: Despite the existence of effective therapies for MS, clinical debate exists regarding the optimal management of patients with this disease. While there are few clear answers to the questions posed by current issues in MS management, with careful consideration and investigation of existing medical evidence, the best course of action for the patient with MS can be estimated and hopefully refined in years to come. J Manag Care Pharm. 2009;15(1)(Suppl S-b):S1-S17 Copyright © 2009, Academy of Managed Care Pharmacy. All rights reserved. MELODY RYAN, PharmD, MPH, GCP, BCPS, is Associate Professor, Department of Pharmacy Practice and Science and Department of Neurology, University of Kentucky Chandler Medical Center, Lexington, Kentucky. AUTHOR CORRESPONDENCE: Melody Ryan, PharmD, MPH, Associate Professor, University of Kentucky Chandler Medical Center, 800 Rose Street, Room C117, Lexington, KY 40536-0293. Tel: 859.257.8790; Fax: 859.323.0069; E-mail: maryan1@pop.uky.edu SARA DENO, PharmD, is Clinical Services Manager, BioScrip, Eden Prairie, Minnesota. AUTHOR CORRESPONDENCE: Sara Deno, PharmD, Clinical Services Manager, BioScrip, Inc., 10050 Crosstown Circle, Suite 300, Eden Prairie, Minnesota, 55344. Tel: 952.979.3690; Fax: 952.352.6663; E-mail: sdeno@bioscrip.com HOWARD L. ZWIBEL, MD, is Medical Director, The Multiple Sclerosis Center at Doctors Hospital, Coral Gables, Florida. AUTHOR CORRESPONDENCE: Howard Zwibel, MD, Medical Director, The Multiple Sclerosis Center at Doctors Hospital, 6862 Granada Boulevard, Coral Gables, Florida 33146. Tel: 305.665.2344; Fax: 305.662.8775; E-mail: zwibelmdms@aol.com Authors