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Stepped-care approach to treating MS: a managed care treatment algorithm
Sheldon R Rich1, Imelda C Coleman, Richard Cook
1SJR Associates LLC, West Bloomfield, Michigan 48323-3207, USA. SJRAssociates@aol.com
Journal of Managed Care Pharmacy : JMCP
|July 16, 2004
Summary
This study introduces a stepped-care treatment algorithm for multiple sclerosis (MS) to manage the chronic condition and delay disease progression. The model emphasizes platform therapy and adding agents as needed for effective long-term MS management.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Multiple sclerosis (MS) is a chronic central nervous system inflammatory disorder.
- MS is characterized by progressive disability and cognitive dysfunction.
- Effective long-term management strategies are crucial for delaying MS progression.
Purpose of the Study:
- To introduce a model treatment algorithm for MS management in managed care settings.
- To provide a strategy for ongoing disease management and long-term care.
- To delay disease progression, disability, and cognitive dysfunction in MS patients.
Main Methods:
- Review of a stepped-care approach for MS treatment.
- Concept of platform therapy providing baseline immunomodulatory action.
- Consideration of factors for selecting platform therapy, including efficacy and neutralizing antibodies (NAbs).
Main Results:
- Interferon beta (IFNbeta) products and glatiramer acetate are approved first-line therapies for relapsing MS.
- IFNbetas are generally recommended as platform therapy due to demonstrated effects on relapses, MRI parameters, and disability progression.
- Incidence of NAbs varies among IFNbeta formulations, potentially impacting efficacy.
Conclusions:
- A stepped-care approach is an effective method for managing MS.
- The model algorithm aims to delay disease progression and associated disability and cognitive impairment.
- Adding agents to platform therapy can improve disease control as MS progresses.