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Updated: Sep 19, 2025
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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
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First-Line Use of Higher-Efficacy Disease-Modifying Therapies in Multiple Sclerosis: Canadian Consensus
Mark S Freedman1, Fraser Clift2, Virginia Devonshire3
1University of Ottawa Department of Medicine, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Summary
Higher-efficacy disease-modifying therapies (HE-DMTs) are crucial for managing multiple sclerosis (MS) progression. This consensus provides expert guidelines on optimal HE-DMT use for improved patient outcomes.
Area of Science:
- Neurology
- Immunology
- Neuroimmunology
Background:
- Multiple sclerosis (MS) involves central nervous system inflammation driving neuroaxonal damage and disability.
- Higher-efficacy disease-modifying therapies (HE-DMTs) are increasingly necessary for managing complex MS pathology and improving long-term outcomes.
Purpose of the Study:
- To establish consensus recommendations for the optimal use of HE-DMTs in clinical practice for multiple sclerosis.
- To provide practical guidelines for Canadian clinicians treating individuals with MS.
Main Methods:
- A Canadian panel of 12 MS experts convened.
- The Delphi method was employed to develop 27 consensus recommendations.
- Considered HE-DMTs included monoclonal antibodies (natalizumab, ocrelizumab, ofatumumab) and immune reconstitution agents (alemtuzumab, cladribine).
Main Results:
- Recommendations cover defining aggressive MS, patient selection for HE-DMTs, and necessary baseline investigations.
- Guidelines address efficacy monitoring, identifying suboptimal responses, and the role of serum neurofilament-light chain.
- The consensus also includes guidance on safety monitoring, aging/immunosenescence, and treatment de-escalation or discontinuation.
Conclusions:
- The consensus recommendations aim to standardize the use of HE-DMTs in MS management.
- Implementing these guidelines is expected to enhance long-term outcomes for individuals with multiple sclerosis.
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