Dr Jan Hillert Discusses Treatment Approaches in MS

Jan Hillert, MD, PhD, professor and senior physician in the department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden, discusses whether the medical community has reached a consensus on using an escalation approach to treatment or starting with highly effective therapies in treating multiple sclerosis (MS).

Transcript

Is there a consensus on whether to use an escalation approach or to use highly effective treatments initially in treating MS?

No. There is no consensus on this. And there are some studies, some observational studies, indicating that there might be advantages with starting with today’s second-line treatments. We don’t know that for sure. There is no consensus.

But I would like to point out that the traditional way of escalation was never a thought-of regimen. It was not something that we just conceived, never something that happened logically with the introduction of less efficacious drugs early and then more efficacious drugs later. It just emerged. It was never a hypothesis that that should be the way.

I’m looking forward to seeing more studies, observational studies from the MS registries, proving if there is an advantage in hitting hard at the early stage.

But I would like to emphasize also that even the first-generation drugs, if you start early enough, have a tremendous effect on the outcome 10 years later. We’ve seen that in several studies. The timing of the first generation of drugs is really important by 10 years down the road. That, to me, is probably something that is overlooked: Even the first-generation drugs are really quite impressive in the long term.