This Peer Exchange is moderated by Fred D. Lublin, MD, FAAN, FANA, Saunders Family Professor of Neurology and director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Icahn School of Medicine at Mount Sinai, New York.
The panelists are:
Patricia K. Coyle, MD, professor and vice chair (Clinical Affairs) and director of the Multiple Sclerosis Comprehensive Care Center at Stony Brook University Medical Center, New York
Clyde E. Markowitz, MD, associate professor of neurology and director of the Multiple Sclerosis Comprehensive Care Center at Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Claire S. Riley, MD, assistant professor of neurology and director of the Columbia University Multiple Sclerosis Clinical Care and Research Center, Department of Neurology, Columbia University, New York
Fred D. Lublin, MD, FAAN, FANA: Pat, let’s start with goals of first-line therapy and again, the issue of early intervention.
Patricia K. Coyle, MD: You need an effective disease-modifying therapy that’s going to minimize breakthrough disease activity—clinical and on the MRI scan. I think, by consensus recently suggested, we’re doing a new baseline brain MRI with or without contrast 6 months after we start a new treatment, and then may go to every year or so.
You also need a disease-modifying therapy that’s going to be tolerated by the patient, and this is where the shared decision making becomes very important. So, you have a discussion because you need to come up from the get-go. You don’t want to set yourself up for failure. You want to choose what you feel is the optimal disease-modifying therapy that’s going to be a good experience for the patient, from the beginning, to control their disease.
So, my goal is minimal to no breakthrough disease activity in a very tolerated therapeutic regimen, where the patient’s self-report is saying, “I’m really doing very well, I feel very well.” I want them to have a normal life. That’s what I want to be able to tell them—“If you work with me, if you stay on treatment, you’re going to have a normal life.”
Claire S. Riley, MD: I take a very similar approach. We want to control the disease activity as completely as possible, and also with a risk-benefit ratio that’s acceptable to the patient. Everybody’s different in terms of how they interpret risk. It’s been sort of a sociologic lesson that I’ve found in my practice. I can’t always predict how people are going to respond to risk parameters. They’re not necessarily the same as what I think. But, I present the information on what I think the optimal therapy would be and then we make that decision together.
The discussion continues at the below link:
http://www.hcplive.com/peer-exchange...nitial-therapy
The panelists are:
Patricia K. Coyle, MD, professor and vice chair (Clinical Affairs) and director of the Multiple Sclerosis Comprehensive Care Center at Stony Brook University Medical Center, New York
Clyde E. Markowitz, MD, associate professor of neurology and director of the Multiple Sclerosis Comprehensive Care Center at Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Claire S. Riley, MD, assistant professor of neurology and director of the Columbia University Multiple Sclerosis Clinical Care and Research Center, Department of Neurology, Columbia University, New York
Fred D. Lublin, MD, FAAN, FANA: Pat, let’s start with goals of first-line therapy and again, the issue of early intervention.
Patricia K. Coyle, MD: You need an effective disease-modifying therapy that’s going to minimize breakthrough disease activity—clinical and on the MRI scan. I think, by consensus recently suggested, we’re doing a new baseline brain MRI with or without contrast 6 months after we start a new treatment, and then may go to every year or so.
You also need a disease-modifying therapy that’s going to be tolerated by the patient, and this is where the shared decision making becomes very important. So, you have a discussion because you need to come up from the get-go. You don’t want to set yourself up for failure. You want to choose what you feel is the optimal disease-modifying therapy that’s going to be a good experience for the patient, from the beginning, to control their disease.
So, my goal is minimal to no breakthrough disease activity in a very tolerated therapeutic regimen, where the patient’s self-report is saying, “I’m really doing very well, I feel very well.” I want them to have a normal life. That’s what I want to be able to tell them—“If you work with me, if you stay on treatment, you’re going to have a normal life.”
Claire S. Riley, MD: I take a very similar approach. We want to control the disease activity as completely as possible, and also with a risk-benefit ratio that’s acceptable to the patient. Everybody’s different in terms of how they interpret risk. It’s been sort of a sociologic lesson that I’ve found in my practice. I can’t always predict how people are going to respond to risk parameters. They’re not necessarily the same as what I think. But, I present the information on what I think the optimal therapy would be and then we make that decision together.
The discussion continues at the below link:
http://www.hcplive.com/peer-exchange...nitial-therapy
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