multiple%20sclerosis
MULTIPLE SCLEROSIS
Treatment Guideline Chart
Multiple sclerosis is an acquired, chronic, immune-mediated, inflammatory disease of the brain and the spinal cord characterized by the presence of multiple discrete areas of myelin loss within the CNS and subsequent axonal degeneration.
It affects more women than men; however, men are more likely to have a malignant clinical course.
A multiple sclerosis attack is usually characterized by any neurological disturbance with minimum 24 hours duration in the absence of fever or infection.

Multiple Sclerosis References

  1. Calabresi PA. Diagnosis and management of multiple sclerosis. Am Fam Physician. 2004 Nov;70(10):1935-1944. PMID: 15571060
  2. Compston A, Coles A. Multiple sclerosis. Lancet. 2002 Apr;359(9313):1221-1231. PMID: 11955556
  3. Beta interferons for multiple sclerosis. Med Lett Drugs Ther. 2002 Oct;44(1141):88-89. PMID: 12381969
  4. Courtney AM, Treadaway K, Remington G, et al. Multiple sclerosis. Med Clin North Am. 2009 Mar;93(2):451-476. doi: 10.1016/j.mcna.2008.09.014. PMID: 19272518
  5. Noseworthy JH. Treatment of multiple sclerosis and related disorders: What's new in the past 2 years. Clin Neuropharmacol. 2003 Jan;26(1):28-37. PMID: 12567162
  6. Noseworthy JH, Luchinetti C, Rodriguez M, et al. Multiple sclerosis. N Engl J Med. 2000 Sep;343(13):938-952. PMID: 11006371
  7. Goodin DS, Frohman EM, Garmany GP, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002 Jan;58(2):169-178. PMID: 11805241
  8. Schapiro RT. Managing symptoms of multiple sclerosis. Neurol Clin. 2005 Feb;23(1):177-187. PMID: 15661093
  9. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 Feb;69(2):292-302. PMID: 21387374
  10. O'Connor P; Canadian Multiple Sclerosis Working Group. Key issues in the diagnosis and treatment of multiple sclerosis. An overview. Neurology. 2002 Sep;59(6)(Suppl 3):S1-S33. PMID: 12448786
  11. Polman CH, Thompson AJ, Murray TJ, et al. Multiple sclerosis: the guide to treatment and management. 5th ed. New York: Multiple Sclerosis International Federation; 2001
  12. Lublin FD, Miller AE. Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In: Bradley W, Daroff R, Fenichel G, et al, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia: Butterworth Heinemann Elsevier; 2008
  13. MedWormhttp://www.medworm.com/rss/index.php/Neurology/25/http://www.medworm.com/rss/medicalfeeds/specialities/Neurology.xml
  14. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  15. National Multiple Sclerosis Society and Multiple Sclerosis International Federation. 2005 revised McDonald diagnostic criteria for MS. 2005.
  16. National Multiple Sclerosis Society. Disease management consensus statement from the medical advisory board of the national multiple sclerosis society. National Multiple Sclerosis Society. http://www.nationalmssociety.org. 2005.
  17. Dashe JF. Diagnosis of multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 03 Jun 2011. Accessed 21 Sep 2011.
  18. Dashe JF. Epidemiology and clinical features of multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 15 Jun 2011. Accessed 21 Sep 2011.
  19. Dashe JF. Comorbid problems associated with multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 14 Mar 2011. Accessed 21 Sep 2011.
  20. Fox RJ, Sweeney PJ. Multiple sclerosis. Cleveland Clinic. http://www.clevelandclinicmeded.com. May 2004. Accessed 02 May 2007.
  21. National Multiple Sclerosis Society. International panel revises diagnostic criteria for MS. National Multiple Sclerosis Society. http://www.nationalmssociety.org/. May 2001.
  22. National Institute of Neurological Disorders and Stroke. Multiple sclerosis. NINDS. http://www.ninds.nih.gov. 14 Aug 2012. Accessed 11 May 2012.
  23. National Multiple Sclerosis Society. Prognosis. National Multiple Sclerosis Society. http://www.nationalmssociety.org. 2005.
  24. National Institute for Health and Care Excellence. Multiple sclerosis: management of multiple sclerosis in primary and secondary care. CG 8. NICE. http://www.nice.org.uk. 2003.
  25. National Collaborating Centre for Chronic Conditions (UK). Multiple sclerosis: national clinical guideline for diagnosis and management in primary and secondary care. NICE. http://www.nice.org.uk. 2004.
  26. Dashe JF. Treatment of progressive multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 02 Jun 2011. Accessed 21 Sep 2011.
  27. Dashe JF. Treatment of relapsing-remitting multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 17 May 2011. Accessed 21 Sep 2011.
  28. National Institute for Health and Care Excellence (NICE). Alemtuzumab for treating relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. May 2014. Accessed 11 Aug 2014.
  29. National Institute for Health and Care Excellence (NICE). Teriflunomide for treating relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Jan 2014. Accessed 11 Aug 2014.
  30. Yadav V, Bever C, Bowen J, et al. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Neurology. 2014 Mar;82(12):1083-1092. http://www.neurology.org. Accessed 11 Aug 2014. PMID: 24663230
  31. Ministry of Health Malaysia. Clinical practice guidelines on management of multiple sclerosis. MOH Malaysia. http://www.acadmed.org.my. 2015. Accessed 24 Apr 2016.
  32. National Institute for Health and Care Excellence. Multiple sclerosis in adults: management clinical guideline. NICE. http://www.nice.org.uk. Oct 2014. Accessed 24 Apr 2016.
  33. Scolding N, Barnes D, Cader S, et al. Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis. Pract Neurol. 2015 Aug;15(4):273-279. doi: 10.1136/practneurol-2015-001139. PMID: 26101071
  34. Brayfield, A, ed. Martindale: the complete drug reference. http://www.medicinescomplete.com. 2018. Accessed 09 Nov 2018.
  35. Clinical Key. Drug information provided by Gold Standard. https://www.clinicalkey.com. 2018. Accessed 09 Nov 2018.
  36. Lublin FD. New multiple sclerosis phenotypic classification. Eur Neurol . 2014;72(Suppl 1):1-5. doi: 10.1159/000367614. PMID: 25278115
  37. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014 Jul;83(3):278-286. doi: 10.1212/WNL.0000000000000560. Accessed 13 Nov 2018. PMID: 24871874
  38. Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018 Feb;24(2):96-120. doi: 10.1177/1352458517751049. PMID: 29353550
  39. National Institute for Health and Care Excellence (NICE). Beta interferons and glatiramer acetate for treating multiple sclerosis. NICE. http://www.nice.org.uk. Jun 2018.
  40. National Institute for Health and Care Excellence (NICE). Cladribine tablets for treating relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Dec 2017.
  41. National Institute for Health and Care Excellence (NICE). Dimethyl fumarate for treating relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Aug 2014.
  42. National Institute for Health and Care Excellence (NICE). Fingolimod for the treatment of highly active relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Jul 2018.
  43. National Institute for Health and Care Excellence (NICE). Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Aug 2007.
  44. National Institute for Health and Care Excellence (NICE). Ocrelizumab for treating relapsing-remitting multiple sclerosis. NICE. http://www.nice.org.uk. Jul 2018.
  45. National Multiple Sclerosis Society. Diagnostic criteria. National Multiple Sclerosis Society. http://www.nationalmssociety.org. 2018. Accessed 07 Nov 2018.
  46. National Multiple Sclerosis Society. Plasmapheresis. National Multiple Sclerosis Society. http://www.nationalmssociety.org. 2018. Accessed 13 Nov 2018.
  47. National Multiple Sclerosis Society. Primary progressive multiple sclerosis. National Multiple Sclerosis Society. http://www.nationalmssociety.org. 2018. Accessed 07 Nov 2018.
  48. Olek MJ. Clinical presentation, course, and prognosis of multiple sclerosis in adults. UpToDate. https://www.uptodate.com. Jun 2018. Accessed 07 Nov 2018.
  49. Olek MJ. Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 31 Oct 2018. Accessed 09 Nov 2018.
  50. Olek MJ, Howard J. Treatment of acute exacerbations of multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 09 Oct 2018. Accessed 09 Nov 2018.
  51. Olek MJ. Treatment of progressive multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 16 May 2018. Accessed 09 Nov 2018.
  52. Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline: disease-modifying therapies for adults with multiple sclerosis. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018 Apr;90(17):777-788. doi: 10.1212/WNL.0000000000005347. Accessed 08 Nov 2018
  53. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-173. doi: 10.1016/S1474-4422(17)30470-2. PMID: 29275977
  54. Farez MF, Correale J, Armstrong MJ, et al. Practice guideline update summary: vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2019 Sep 24;93(13):584-594. doi: 10.1212/WNL.0000000000008157. Accessed 12 May 2020. PMID: 31462584
  55. National Institute for Health and Care Excellence (NICE). Disease-modifying therapies for multiple sclerosis. NICE. https://www.nice.org.uk. 24 Apr 2020. Accessed 12 May 2020.
  56. U.S. Food and Drug Administration (US FDA). Mayzent prescribing information. US FDA. https://www.accessdata.fda.gov. Mar 2019. Accessed 14 May 2020.
  57. U.S. Food and Drug Administration (US FDA). Plegridy prescribing information. US FDA. https://www.accessdata.fda.gov. Jul 2016. Accessed 18 May 2020.
  58. Yamout B, Sahraian M, Bohlega S, et al. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines. Mult Scler Relat Disord. 2020 Jan;37:101459. doi: 10.1016/j.msard.2019.101459. PMID: 31670208
  59. Al Sharoqi IA, Aljumah M, Bohlega S, et al. Immune reconstitution therapy or continuous immunosuppression for the management of active relapsing-remitting multiple sclerosis patients? A narrative review. Neurol Ther. 2020 Jun;9(1):55-66. doi: 10.1007/s40120-020-00187-3. PMID: 32297127
  60. Olek MJ, Narayan RM, Frohman EL, et. al. Symptom management of multiple sclerosis in adults. UpToDate. https://www.uptodate.com. 1 Nov 2019.
  61. Olek MJ, Mowry E. Disease-modifying therapies for multiple sclerosis: pharmacology, administration, and adverse effects. UpToDate. https://www.uptodate.com. 14 Apr 2021. Accessed 19 Apr 2021.
  62. Cohen JA, Comi G, Selmaj KW, et al. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial. The Lancet Neurology. 2019 Nov;18(11):1021-1033. doi: 10.1016/S1474-4422(19)30238-8.
  63. Comi G, Kappos L, Selmaj KW, et al. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial. The Lancet Neurology. 2019 Nov;18(11):1009-1020. doi: 10.1016/S1474-4422(19)30239-X.
  64. D'Ambrosio D, Freedman MS, Prinz J. Ponesimod, a selective S1P1 receptor modulator: a potential treatment for multiple sclerosis and other immune-mediated diseases. Ther Adv Chronic Dis. 2016 Jan;7(1):18-33. doi: 10.1177/2040622315617354. PMID: 26770667
  65. Freedman MS, Devonshire V, Duquette P, et al. Canadian MS Working Group. Treatment optimization in multiple sclerosis: Canadian MS working group recommendations. Can J Neurol Sci. 2020 Jul;47(4):437-455. doi: 10.1017/cjn.2020.66. PMID: 32654681
  66. Hauser SL, Cree BAC. Treatment of multiple sclerosis: a review. Am J Med. 2020 Dec;133(12):1380-1390.e2. doi: 10.1016/j.amjmed.2020.05.049. Accessed 12 Oct 2020. PMID: 32682869
  67. Kappos L, Fox RJ, Burcklen M, et al. Ponesimod compared With Teriflunomide in patients with relapsing multiple sclerosis in the active-comparator phase 3 OPTIMUM study: randomized clinical trial. JAMA Neurol. 2021 Mar:E1-E10. doi: 10.1001/jamaneurol.2021.0405. Accessed 19 Apr 2021
  68. Sellner J, Rommer PS. Immunological consequences of "immune reconstitution therapy" in multiple sclerosis: a systematic review. Autoimmun Rev. 2020 Apr;19(4):102492. doi: 10.1016/j.autrev.2020.102492. Accessed 29 Mar 2021. PMID: 32062028
Editor's Recommendations
Special Reports