June Halper on Challenges With Identifying Which Multiple Sclerosis Treatments Have the Most Promise

Identifying which treatments for multiple sclerosis have the most promise is challenging because there are no head-to-head studies comparing treatments and what's promising for one clinician is different than what's promising for another clinician, explained June Halper, MSN, APN-C, MSCN, FAAN, chief executive officer, Consortium of Multiple Sclerosis Centers.

Within the last year or so, what treatments have been demonstrating the greatest promise in managing multiple sclerosis?
It’s a hard question to answer in terms of what has shown the greatest promise. If you ask patients, they would probably answer marijuana because pot is becoming legalized in a number of states, and in many instances, patients consider that a treatment. When we talk about disease-modifying therapy, there really are no head-to-head studies where you would say Betaseron or Avonex or better than Gilenya. So, we really don’t know which is the most promising.

What’s the most promising for one clinician is different for another clinicians. I guess we have to wait to see if, one, there will be a comparable study. I doubt it. But more and more, we’re going to see things like roundtables like you do here in your organization to try and get some expert opinion, to listen to the key opinion leaders who can say, “In my experience, "X" medication works better than "Y" medication on patients that have had MS [multiple sclerosis] for less than 5 years and have the following picture.” I think that’s the thing we have to rely on most, at least for now, is the expert opinion and the widespread experience that clinicians have with the various drugs.

The other problem we face is the insurance companies, they might not have particular drugs in their formularies, so certain clinicians may not be able to analyze their outcome or their benefit because their patients might not be entitled to get them. In this country, we have a wide variety of challenges. In Canada for example, it’s a nationalized health system, so they have access to all the drugs.

So, that question’s a tough question that I’m hoping will be answered, mainly by expert opinion and long-standing experience, over the next few years.
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