ECTRIMS: Overcoming Uncertainty When Managing MS Relapse

In new research presented at the ECTRIMS meet­ing, 74 MS specialists completed 2 sequential web-based surveys.

Consensus was defined as a similar response by ≥75% of respondents; majority agreement was de­fined as a similar response by >50% but <75% of respondents. The respondent demographics showed that 76% treat between 1 and 1000 patients with MS and the remaining 24% treat between 1000 and 2000 patients. The majority of the respondents (51%) characterized their clinical practice as an MS center, while 29% said general community practice and 20% said academic practice.

When asked about the definition, treatment, and management of relapse, there were areas of consen­sus, but also a number of areas in which treatment practice vary. In confirming MS, there was consensus on the need for new or worsened symptoms lasting for at least 24 hours (79%) and the absence of fever and clinical laboratory signs of infections (81%). Responses differed on whether the following were required to confirm MS:

• Absence of symptoms for ≥30 days before the current event (59% responded “All the time”)

• ≥1 patient-reported symptom of relapse (55% responded “All the time”)

• Magnetic resonance imaging evidence of relapse (41% responded “Some of the time”)

• Objective signs of relapse based on neurological exam (46% responded “Most of the time”)

With regard to MS relapse, consensus existed on the need to consider comorbidities (100%) and cost (76%), particularly drug costs to patients (95%). Respondents also expressed a willingness to change their typical dosing regimen for high-dose IV corticosteroids in response to the severity of MS relapse (78%) and to change treatment if a patient was nonresponsive during a previous MS relapse and the current relapse affects the same functional system (76%).

Consensus was also reached on use of methylpred­nisolone as the preferred formulation for high-dose IV corticosteroid treatment (98%) and the need to as­sess patient recovery from relapse (93%). Responses differed regarding the use of other treatment options and preference for treatment transitions.—Eileen Koutnik-Fotopoulos

This study was supported by funding from Mallinckrodt Pharmaceuticals.