Updated Multiple Sclerosis Guidelines in Development

New guidelines seek to address inconsistency in the approach to treatment.

Although many new drugs have been approved in the disease state of multiple sclerosis (MS) in recent years, guidelines have lagged behind. These guidelines fail to include such medications as Gilenya (fingolimod), Tecfidera (dimethyl fumarate), and Aubagio (teriflunomide). In the UK, the most up-to-date guidelines date back more than 10 years to 2003.¹

Limitations of the previous guidelines include a lack of guideline-based descriptions of appropriate methods for managing MS symptoms, limiting the discussion only to disease-modifying therapies. In an article published in a late November edition of the journal Lancet regarding the development of these new guidelines, panelist Paul Cooper, a consultant neurologist at the Greater Manchester Neuroscience Centre stated, “The quality of our services has up to now been notoriously patchy, with patients getting excellent service in some places and poor service in others.”¹

With updated guidelines, the UK's treatment of patients with MS may improve across the country through a more consistent treatment approach. Likewise, in the United States the lack of guidelines has also affected the consistency of treatment. The development of new guidelines in the UK may inspire neurologist societies in the United States to update US guidelines, which are similarly well out of date.^1,2

The most recent US guidelines, which were published in 2002 and reaffirmed in 2006 by the American Academy of Neurology (AAN), have only been updated twice. The first update was a statement on the use of mitoxantrone issued in 2003 and the second was a statement on the use of natalizumab issued in 2007. More recent updates published in 2014 include guidance on the use of complementary medicine and cannabis, as well as the treatment of comorbid psychiatric disorders.

These updates suggest that a new main-line treatment guideline may be arriving soon, although the AAN website goes no further than to say that an update is “in progress.”

With the development of new guidelines in the UK, a new set of US guidelines are likely to follow.^1,2

References:

• Maurice J. Multiple sclerosis guideline production takes off. Lancet. 2014;384(9958):1914-1915.
• American Academy of Neurology. Multiple Sclerosis. https://www.aan.com/Guidelines/Home/ByTopic?topicId=18. Accessed December 10, 2014.