Multiple factors come into play when providers and patients discuss a disease-modifying therapy for multiple sclerosis (MS), explains Patricia K. Coyle, MD, of Stony Brook University Neurosciences Institute.
What are some of the considerations that clinicians should take into account when choosing a disease-modifying therapy?
Well, I think there are multiple factors in shared-decision making. I think the principle of early treatment is very key. The principle of shared decision making is very key—you want the patient to be a partner. So you want them to be informed and educated to have a true understanding about MS. And then I think principal factors are, what are individual goals and this would also account for, do they have comorbid conditions, what are their lifestyle expectations? Are they looking at pregnancy as something down the line that is important? So there are individual subject goals. There are MS disease goals. How active is their MS? What sort of prognostic profile does the patient have? Someone who has very active disease, somebody that you're very worried about, [they] look like they're fitting into a poor prognosis. Efficacy of your DMT choice now becomes very important, critically important. And then I think finally, the DMT. And this is the mode of delivery, the safety, the tolerability, the adverse events, the efficacy of the drug, the monitoring that is required. These are kind of the principal factors that are calculated into coming up with the best disease-modifying therapy choice for the individual patient.