The increasingly number of available Disease Modifying Therapies (DMTs) have led to enhanced perspectives for treating relapsing multiple sclerosis (RMS). The different DMTs have greatly contributed for a more personalized treatment approach with improved clinical outcomes. Currently the DMT landscape makes the decision to switch between different options complex - considering both their different clinical profiles and patient characteristics, especially in absence of unified recommendations for switching.
The Demyelinating Expert Group of the Spanish Society of Neurology (SEN) considered to carry out a consensus project with the objective of answering critical questions about DMT sequencing for an optimal patient management.
After an exhaustive literature review, the expert group identified 5 main topics to integrate the proposed questions: I) treatment objectives and risk-benefit balance; II) reasons for switching; III) suboptimal response definition; IV) strategies for treatment change; V) washout periods. Delphi´s methodology was used for assessing the level of agreement among the discussed statements.
The expert group workshops leaded to formulate a total number of 106 final statements to cover the defined 5 main topics. From them, consensus (at least 80% of agreement between participants) was reached in 99 responses (93%), while 7 (7%) were finally discarded for lack of agreement.
These Spanish Neurologists´switching recommendations addressed DMT sequencing difficulties that clinicians face in MS clinical practice. Evidence from reviewed literature added to Spanish MS experts´clinical experience resulted in those basic guidelines that will optimize DMT use and patient management in Spain.