A framework of care in multiple sclerosis, part 1: Updated disease classification and disease-modifying therapy use in specific circumstances

The Consortium of Multiple Sclerosis Centers brought together a multidisciplinary group of clinicians and researchers to explore and evaluate current standards in multiple sclerosis (MS) care. This Framework Taskforce comprised 13 clinician-experts from varying fields, including neurology, biostatistics, MS nursing, pharmacy, physician assistants, rehabilitation specialists, psychology, social work, and urology. The methods of this initiative included analysis of a needs assessment survey and an extensive literature review. The outcome is a two-part continuing education series reviewing best practices on specific key topics in MS care. Part 1, presented herein, discusses the background of MS care and focuses on the disease-modifying therapies (DMTs) currently approved by the US Food and Drug Administration for use in MS. Best practices emphasize a comprehensive, multidisciplinary, patient-centered team approach. Included are suggestions for effective communication among health-care team members. Up-to-date information is provided on the clinical course of MS, including current disease-specific terminology, which is of utmost importance in identifying optimal treatments for people with MS. Specific circumstances that health-care providers may encounter are presented, including methods for selecting a DMT, when to switch therapies, and treatment and evaluation considerations when a suboptimal response to therapy occurs. In addition, standardized magnetic resonance imaging is important for diagnosis and follow-up. Magnetic resonance imaging is recommended before starting medication therapy or switching DMTs; new lesions suggest the need to confirm adherence or consider advancing therapy. Shared decision making among health-care providers and people with MS is encouraged.