A therapeutic strategy in multiple sclerosis (MS) that aims to maximize lifelong brain health (neurological reserve) needs to be widely accepted - and urgently adopted. The strategy includes early intervention, a clear treatment target, regular monitoring, improved access to disease-modifying therapies (DMTs). A comprehensive approach to the management of MS which involves adopting a healthy lifestyle and preventing and treating comorbidities is also a vital component.

These recommendations come from a new international evidence-based report, Brain health: time matters in multiple sclerosis.

Evidence shows that DMTs are most effective early in the disease course. The Association of British Neurologists recommends starting treatment with a DMT "as early as possible in eligible patients" in its 2015 guidelines. But treatment initiation and switching are often delayed and may be subject to restrictions in licensing stipulations, prescribing guidelines and reimbursement policies.

"Time is critical to preserving brain volume, cognitive function and physical function, but there are delays at every stage in the treatment pathway," says lead author and neurologist Professor Gavin Giovannoni. "The evidence shows we need to focus on early diagnosis and early intervention and offering effective DMTs that maintain cognitive function and maximize brain health. We need preventative strategies to delay progressive disease and stave off future disability."

The report, authored by an international multidisciplinary expert group, sets out a series of consensus recommendations aimed at achieving the best possible outcomes for people with MS.

The recommendations call for people with relapsing forms of MS to have access to the full range of available DMTs and to be involved in decisions about treatment initiation and timely switching when MRI or clinical evidence indicate disease activity.

The recommendations include:

  • minimize delays in the diagnosis
  • start treatment early, with a disease-modifying therapy and lifestyle measures
  • encourage shared decision-making between people with MS and healthcare professionals
  • manage MS holistically
  • set an explicit treatment target
  • monitor disease activity proactively
  • act swiftly on suboptimal control of disease activity by considering switching DMT
  • collect and record monitoring data to generate real-world evidence
  • carry out economic evaluations from a societal perspective
  • continue to investigate, develop and use cost-effective therapeutic strategies.

The recommendations are endorsed by a number of professional associations and advocacy groups, including the European Brain Council (EBC), the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Multiple Sclerosis Platform (EMSP).

Welcoming the report, Maggie Alexander, Chief Executive of EMSP, says: "This is a timely, challenging report that sets out important policy recommendations with the potential to have a significant impact on the lives of hundreds of thousands of people affected worldwide by multiple sclerosis."

Marco Aurélio Lana-Peixoto, Chief Executive of the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS), said: "This report is an outstanding milestone to guide clinicians to approach MS appropriately, according to the most recent scientific evidence."

Brain health: time matters in multiple sclerosis was launched at a symposium on Tuesday 6 October, on the eve of the 31st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), in Barcelona, Spain.