Barry Singer, MD, is the director of the MS Center for Innovations in Care at Missouri Baptist Medical Center in St. Louis, Missouri. He breaks down how to spot early signs of breakthrough disease activity and why monitoring progression is key to timely treatment decisions.
Transcript
Yeah. So usually with multiple sclerosis, we know pretty quickly if a medication is not working. The easy way, like in a younger patient with active disease, relapsing disease, is new relapses. And so if you do have a new relapse a few months on treatment and then, let’s say, even have another one, that would be very high.
Some of our MS medications in clinical trials are getting down to the equivalent of one relapse every 10 years or further. So if you’re having breakthrough relapses, that’s a concern.
If you are having new MRI activity — so you do follow-up MRI scans on treatment and you have new lesions, called T2 lesions or contrast active lesions — if we see these new lesions, then that’s a sign that disease is breaking through.
And you may figure that out within a year or six months that something is not working well, particularly for someone with active disease that’s not well controlled. So those are important things that we look at.
Now, slow progression over time can sneak up both on people living with MS as well as providers. And we’ve seen some studies that show that sometimes it’s years before someone is really identified as having secondary progressive MS.
So it’ll be more important to pick up progressive MS as we move forward in the future, because we’re going to have new treatments to hopefully help progressive MS.
