People with relapsing remitting MS should be considering starting disease modifying treatment as early as possible and be active partners in treatment choices according to newly revised guidelines published today by the Association of British Neurologists (ABN).
The guidelines set out best practice in prescribing and monitoring disease modifying therapy. They take account of new drugs and advances in diagnosing MS that have occurred since the previous revision in 2009.
The ABN recognises that the disease modifying treatments - of which eleven are now licensed in the UK - have a significant impact on relapsing MS. People with MS can have relapses and worsening symptoms but the disease can also be silently active which can only be observed by scanning the brain. MRI scanning allows neurologists to understand underlying disease activity in MS and make changes to treatment plans.
MS teams, including MS neurologists and specialist nurses, should help people understand their options, including the potential impact of leaving the disease untreated, and to make the choice that is right for them. The MS team should continue to monitor people on disease modifying treatments and consider the possibility of switching to another drug should the person's MS continue to be active.
The ABN also sought comment on these guidelines from the MS Trust and the MS Society, stressing the strong commitment amongst MS neurologists to involving people with MS in what can be complex and difficult decision making. The guideline emphasises the importance of shared decision making and the "vital role of MS specialist nurses".
Amy Bowen, Director of Service Development, MS Trust said, "The revised guidelines from the ABN herald a new era in MS care. Treatment choices are increasingly complex and expert guidance is vital to ensure people with MS can make the choices that are right for them. The MS Trust was glad to have the opportunity to comment on the guidelines.
"There is a much greater emphasis in the guidelines on starting drug treatment earlier and on monitoring for the effectiveness of treatment, including more use of MRI scans As the focus on earlier treatment and monitoring of disease activity increases, it is equally important that MS services are supported to develop their services accordingly. It is also essential that this is done in a way that ensures everyone affected by MS continues to receive high quality care. Research by the MS Trust has shown that there is a shortfall of MS nurses and we are aware that there are too few neurologists who specialise in MS. It will require coordinated effort by many in the MS community to ensure there is the capacity in MS services to meet the need now and in the future."
Disease modifying treatment rates in the UK are low compared to other countries in Europe and North America. There is much to do to improve this and it will take collaborative work by the whole MS community to understand and remove the barriers. Over the next year, the MS Trust will be
- Launching a revised version of MS Decisions, an online resource to help people choosing between disease modifying treatments
- Collaborating with other MS charities to raise awareness amongst people affected by MS about the importance of starting treatment earlier and of monitoring disease activity
- Publishing evidence from our GEMSS programme about the availability, value and impact of MS services and working alongside MS health professionals to help ensure equitable access to high quality services.
- Working with organisations across the MS community, to launch a project supporting MS services to improve service capacity.
- Continuing to train and support MS specialist nurses and allied health professionals to ensure that everyone affected by MS can receive the best possible care
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