In the treatment of relapsing multiple sclerosis (RMS), finding the right balance between efficacy and safety remains a challenge. Advances in monotherapy options have shown significant efficacy in reducing relapse rates and slowing disease progression. However, these benefits must be weighed against potential risks, including in some cases, the heightened risk of progressive multifocal leukoencephalopathy (PML).
Recent studies emphasize the importance of patient-centered approaches when managing RMS. Tailoring treatment to individual patient profiles—including disease activity, prior treatment history, and risk factors—can optimize outcomes while mitigating risks. As the therapeutic landscape evolves, clinicians must continuously reassess the benefit-risk ratio of treatments like natalizumab to ensure the best outcomes for their patients.
How do you balance the efficacy and safety of treatment options in RMS? What factors most influence your decision-making process when choosing monotherapy for your patients?
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Indravadan Gatiwala, Neurology center of Lumberton, Inc1yrwe start our patients with the Ocrevus or kesimpta . Both medications are very efficacious. These treatment are available for the relapsing remitting, multiple sclerosis and they are well tolerated. Ocrevus is twice a year infusion. Kesimpta is every 4 week subcutaneous injection .
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Pavle Repovic, SWEDISH MEDICAL CENTER - FIRST HILL CAMPUS1yrI tend to use high efficacy therapies for all of my newly diagnosed patients, unless there is a strong reason not to (older patient, significant comorbidities), or if the patient is strongly opposed to immunosuppressive meds.
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Andrew Rogove, SOUTHSIDE HOSPITAL1yrIn general I tend to prefer to start with high efficacy disease modifying therapies. I will discuss treatment options (dosing, benefots, risk, etc) with my patients and let them decide which therapy they feel is best for them. Once they decide I take all necessary precautions like ordering JCV antibodies, assessing for hepatitis infection, assessing for VZV immunity, etc. Once the patient completes testing, I will let them know if their choice is still a good choice and if so start them on it, if not I will try the most efficacious drug that I can
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Rikki Racela, Bergen Neurology1yrI balance the efficacy and safety of treatment options in RMS by saving more dangerous medications for later lines. The factors that most influence my decision-making process when choosing monotherapy for my patients including safety, tolerability, and efficacy.
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Anne Solomon, Neurologic associates1yrWe use a great deal of Tysabri in our practice. We check the JC virus titer often and use it to stratify risk. We have changed the dose interval from every 4 weeks to every or even 8 weeks to continue patients on this treatment.