MS damages the brain from the start of the disease and clinicians are challenged to treat the disease early before irreparable damage to the brain and its limited mechanisms for repair are damaged. There is consensus on the importance of early intervention to maximize lifelong brain health.¹ Cognitive health is impaired before walking ability, and cognitive deficit, not walking ability, has the biggest impact on employment in people with MS.²  Survey respondents from both the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry and the American Academy of Neurology MS Disease Modifying Treatment (DMT) guideline development panel cited the “selection of therapies most likely to lead to improvements in quality-of-life measures, MS symptoms, and preservation of cognition" as top priorities in DMT selection.³

Monoclonal antibody (mAb) therapies have become one of the preferred treatments for relapsing and progressive forms of MS as they target specific mechanisms of the disease. Clinically, their use can be found as “induction” agents or later as “escalation” therapies after patients fail less efficacious drugs. FDA approved agents, alemtuzumab, natalizumab, ocrelizumab, and ofatumumab are each proven to be safe, highly therapeutic agents with unique benefits and risks. Delivery of these treatments is either intravenous or subcutaneous, and varies from monthly, every six months, or annual cycles. Patients self-administer or attend infusion centers with varying delivery times based upon the drug received.

Given the importance of maximizing brain health, what is your approach to treating MS early?

How do you and your patients weigh quality-of-life, symptom improvement, and preservation of cognition in determining the best course of treatment for them? 

1. Giovannoni, G, Butzkueven H, Dib-Jalbut S, et al Brain Health: time matters in multiple sclerosis. UK: Oxford PharmaGenesis, 2015. Google Scholar
2. Strober L, Ciaravalloti N, Moore N, et al Unemployment in multiple sclerosis (MS); utility of the MS Functional Composite and cognitive testing. Mult Scler 2014; 20:112-5. Doi: 10.1177/1352458513488235 CrossRefPubMed Google Scholar
3. Gregory S. Day, Alexander Rae-Grant, Melissa J. Armstrong, et al. Identifying priority outcomes that influence selection of disease-modifying therapies in MS. Neurol Clin Pract published online April 23, 2018. DOI 10.1212/CPJ.0000000000000449
4. Elsbernd PM, Carter JL. Using Monoclonal Antibody Therapies for Multiple Sclerosis: A Review. Biologics. 2021; 15:255-263. https://doi.org/10.2147/BTT.S267273