Switching Therapies in MS: What Are the Options?

Relapses or suboptimal response in multiple sclerosis (MS), also known as breakthrough disease, is common, even in patients with good adherence to disease-modifying medications. To confirm breakthrough disease, clinicians must assess adherence, ensuring to manage any adverse effects that could lead to nonadherence; monitor disease course through clinical and MRI measures; and then make treatment adjustments as appropriate. For patients with suboptimal response, clinicians may change the dosage or switch or combine disease-modifying treatments. Switching from first-line treatments (interferon use β or glatiramer acetate) to second-line treatments (natalizumab or mitoxantrone) or to an oral medication (fingolimod, teriflunomide, dimethyl fumarate) requires knowledge of the risks and benefits associated with each agent. Clinicians who recognize breakthrough disease can intervene to reduce disability in their patients with MS.

From the Department of Neurology and the Multiple Sclerosis Center, the Hospital of the University of Pennsylvania, Philadelphia.