Kévin Bigaut1, Mikaël Cohen2, Françoise Durand-Dubief3, Elisabeth Maillard4, Evelyne Planque5, Hélène Zephir6, Christine Lebrun-Frenay2, Jérôme de Seze7. 1. Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Electronic address: kevin.bigaut@chru-strasbourg.fr. 2. Service de Neurologie, Centre Hospitalier Universitaire Pasteur 2, Nice, France. 3. Service de Neurologie, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France. 4. Service de Neurologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France. 5. Service de Neurologie, Centre Hospitalier Emile Durkheim, Epinal, France. 6. Service de Neurologie, Centre Hospitalo-Universitaire de Lille, Lille, France. 7. Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Abstract
BACKGROUND: Today, there are no recommendations on switching disease-modifying treatments (DMTs) in multiple sclerosis (MS). OBJECTIVES: To establish guidelines on switching DMTs MS. METHODS: A Steering Committee composed of seven MS experts from the French Group for Recommendations in Multiple Sclerosis (France4MS) defined 15 proposals. These proposals were then submitted to a Rating Group, composed of 48 French MS experts, for evaluation. The proposals were classified as 'appropriate', 'inappropriate' or 'uncertain'. RESULTS: Switching from a first-line therapy to another first-line therapy or a second-line therapy could be done without a washout period. Switching from a second-line therapy to a first-line therapy could be done without a washout period with fingolimod or natalizumab, after 3 months with ocrelizumab or mitoxantrone, and, if disease activity occurs with alemtuzumab or cladribine. The switch from a second-line therapy to another second-line therapy could be done after a washout period of 1 month with fingolimod or natalizumab, after 3 months with ocrelizumab, after 6 months with mitoxantrone, and, if disease activity occurs, with alemtuzumab or cladribine. CONCLUSION: This expert consensus approach provides physicians with some guidelines on optimizing the benefit/risk ratio when switching DMTs in patients with MS.
BACKGROUND: Today, there are no recommendations on switching disease-modifying treatments (DMTs) in multiple sclerosis (MS). OBJECTIVES: To establish guidelines on switching DMTs MS. METHODS: A Steering Committee composed of seven MS experts from the French Group for Recommendations in Multiple Sclerosis (France4MS) defined 15 proposals. These proposals were then submitted to a Rating Group, composed of 48 French MS experts, for evaluation. The proposals were classified as 'appropriate', 'inappropriate' or 'uncertain'. RESULTS: Switching from a first-line therapy to another first-line therapy or a second-line therapy could be done without a washout period. Switching from a second-line therapy to a first-line therapy could be done without a washout period with fingolimod or natalizumab, after 3 months with ocrelizumab or mitoxantrone, and, if disease activity occurs with alemtuzumab or cladribine. The switch from a second-line therapy to another second-line therapy could be done after a washout period of 1 month with fingolimod or natalizumab, after 3 months with ocrelizumab, after 6 months with mitoxantrone, and, if disease activity occurs, with alemtuzumab or cladribine. CONCLUSION: This expert consensus approach provides physicians with some guidelines on optimizing the benefit/risk ratio when switching DMTs in patients with MS.