by Ralf Gold and Xavier Montalban
In 2016, the EAN president Günther Deuschl and ECTRIMS (European Committee for Treatment and Research in MS) president Xavier Montalban have decided to join the forces of the two societies, and prepare a common guideline for the treatment of multiple sclerosis (MS). In view of the recent increase of medications approved for relapsing- and progressive MS, evidence-based guidance is needed to ensure standardized treatment of MS patients throughout Europe. Keeping in mind the economical restrictions of individual healthcare systems, the guidelines were prepared according to the GRADE system and rather focused on group effects of medications, so that country-specific limitations would mostly allow to substitute with substances not reimbursed in there. Clinically relevant questions were defined based on the PICO system (Patient Intervention Comparator Outcome. The recommendations were then grouped according to their relevance for clinical practice; quality was assessed based on the level of evidence or consensus reached within the guideline group. Specific topics were discussed, including the early treatment in clinically isolated syndrome (CIS), and the effect of first line DMTs in relapsing MS as compared with placebo. Several aspects of clinical management were addressed: When should patients receive stronger `escalating´ treatment with clinical and/or MRI activity? Are there specific follow-up intervals for MRI studies in individual patients? Is there still a role for older injectable medications? Do we observe rebound of MS activity after stopping treatment? In addition, specific aspects of MS treatment and pregnancy were discussed. To collect the data for evidence-based recommendations, some aspects were extracted from judging more than 3000 published studies.
We expect that these European guidelines represent a valuable armamentarium for treating MS in daily clinical practice. The guidelines were supported only by the two societies, with no resources from pharmaceutical companies. Leading European MS scientists and clinicians made their contributions and warranted high-quality. There are some limitations, including, that for progressive MS much more research is needed to enable therapeutic progress also for the most afflicted of our MS patients.
Xavier Montalban for ECTRIMS
Ralf Gold for EAN
ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Montalban X, Gold R, Thompson AJ et al.
Multiple Sclerosis Journal/European Journal of Neurology in press (early online Jan 2018)