Multiple Sclerosis Treatment and Holistic Patient Care Consensus by the Spanish Society of Neurology
José E. Meca Lallana1, Sergio Martínez Yélamos2, Sara Eichau Madueno3, Miguel Ángel Llaneza4, Jesús Martín Martínez5, Joaquín Peña-Martínez6, Virginia Meca-Lallana7, Ana María Alonso Torres8, Ester Moral Torres9, Jordi Río10, Carmen Calles11, Adrián Ares Luque12, Lluis Ramio Torrenta13, María Eugenia Marzo Sola14, José María Prieto15, María Luisa Martínez Ginés16, Rafael Arroyo Gonzalez17, María Ángeles Otano Martínez18, Luis Brieva Ruiz19, Montserrat Gómez Guitiérrez20, Alfredo Rodríguez-Antigüedad Zarranz21, Victoria Galán Sánchez Seco22, Lucienne Costa-Frossard23, Miguel Ángel Hernández Pérez24, Lamberto Landete-Pascual25, Montserrat Gonzalez Platas26, Celia Oreja-Guevara27
1Clinic Neuroimmunology Unit and Multiple Sclerosis CSUR, Department of Neurology. Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), 2Multiple Sclerosis Unit “EMxarxa”. Department of Neurology. H.U. de Bellvitge, 3Department of Neurology, Hospital Universitario Virgen Macarena, 4Department of Neurology, Complejo Hospitalario Universitario de Ferrol, 5Department of Neurology, Hospital Universitario Miguel Servet, 6Department of Neurology, Hospital Universitario San Agustín, 7Department of Neurology, Hospital Universitario La Princesa, 8Multiple Sclerosis Unit, Department of Neurology, Hospital Regional Universitario de Málaga, 9Department of Neurology, Hospital de Sant Joan Despí Moisès Broggi, 10Department of Neurology, CemCat-Vall d’Hebrón, 11Department of Neurology, Hospital Universitari Son Espases, 12Department of Neurology, Complejo Asistencial Universitario de León, 13Multiple Sclerosis and Neuroimmunology Unit, Hospital Universitario Dr. Josep Trueta and Hospital Santa Caterina, 14Department of Neurology, Hospital San Pedro, 15Department of Neurology, Complejo Hospitalario Universitario de Santiago, 16Department of Neurology, Hospital Universitario Gregorio Marañón, 17Department of Neurology, Hospital Universitario Quiron Salud Madrid, 18Department of Neurology, Complejo Hospitalario de Navarra, 19Universitat de Lleida, Hospital Universitari Arnau de Vilanova, 20Department of Neurology, Hospital Universitario de Cáceres, 21Department of Neurology, Hospital Universitario Cruces, 22Department of Neurology, Hospital Universitario de Toledo, 23Multiple Sclerosis Unit, Ramón y Cajal University Hospital, 24Department of Neurology, Hospital Nuestra Señora de Candelaria, 25Department of Neurology, Hospital Universitario Dr Peset, 26Department of Neurology, Hospital Universitario de Canarias, 27Department of Neurology, Hospital Clínico San Carlos, IdISSC
Objective:

We aimed to provide a set of recommendations regarding comprehensive management of multiple sclerosis (MS) patients in Spanish clinical practice.

Background:

To approach MS effectively, recommendations, guidelines, and consensus are needed. Diagnosis, monitoring and disease treatment present several challenges. With numerous disease-modifying therapies (DMTs) available, and the lack of accurate biomarkers for predicting effectiveness and safety, therapeutic decision-making becomes challenging.

Design/Methods:

The Delphi methodology was used to develop the recommendations, which aimed to achieve consensus among experts based on their experience, the latest scientific evidence and the limitations of current resources. There were two rounds of evaluation, completed by 21 panelists who provided feedback on each item.

Results:

Nine dimensions of MS management are covered by the recommendations, including early diagnosis, early start of DMT, escalation versus early start of high-efficacy DMT, face-to-face and remote follow-up, suboptimal response detection, patient perspective, biomarkers and pregnancy, as well as vaccination. The panel recommends that the optic nerve lesions and a spinal MRI should be incorporated into the diagnosis to provide information to guide a therapeutic decision. Following diagnosis, the choice of initial treatment should not be based on the use of “treatment lines”, but primarily on the presence or absence of poor prognostic factors for the occurrence of relapses or disability progression. There are possibilities for telemedicine to supplement or replace some face-to-face follow-ups, but a face-to-face follow-up is recommended after starting the first DMT and in unstable patients. In women considering becoming pregnant, prior to pregnancy planning the patient should be stable and, if not, the treatment should be optimized.

Conclusions:

This consensus provides recommendations for the comprehensive management of MS patients in Spanish clinical practice. It is expected that the recommendations will improve patient care and result in a higher quality of life for the patients.

10.1212/WNL.0000000000204775