Multiple sclerosis (MS) is a chronic disease with multifaceted symptoms that go beyond neurologic components, necessitating enhanced differential diagnosis skills and multidisciplinary care by a collaborative team of specialty and primary care healthcare providers. MS care is an ever-evolving field of disease-modifying therapies and new understandings of the neuropathology and disease progression. This CE activity includes 3 activities with intensive, expert-led discussions for specialists and primary care providers. Topics will include early recognition and differential diagnosis, the latest insights from clinical trials and real-world data on disease-modifying treatment options, recognition of disease progression independent of relapse activity, and avenues to foster collaborative care and shared decision-making.
Courses
Making the MS Diagnosis and Monitoring Its Impact
Credit Available:
ACCME – 1.00 AMA PRA Category 1 credit(s)™
ANCC – This activity is designated for 1.0 contact hours
Course Faculty: Daniel M. Harrison, MD, FAAN
Traditional categorization of multiple sclerosis (MS) as either relapsing-remitting or progressive phenotypes may no longer be correct. Researchers have observed that long-term deterioration frequently occurs independently of relapses in many patients classified as having relapsing-remitting MS. This progression independent of relapse activity (PIRA) is also associated with accelerated brain atrophy. Precise protocols for how to minimize disability accrual in patients with MS and PIRA and the potential different therapeutic sequences are not yet known. It is possible that patients with MS and early PIRA require a wholly distinct treatment approach from disease onset, especially if there is a disproportionate emphasis on annualized relapse rate, as used in many contemporary clinical trials of MS treatments. This CE activity will review evidence supporting the existence of PIRA in patients with MS and its relationship with Expanded Disability Status Scale scores and long-term outcomes; patient demographics associated with early PIRA in MS; methods for optimizing care strategies for patients with MS and PIRA; and the role of PIRA as an endpoint in future clinical trials of experimental therapies for MS.
Increasing DMT Options, Increasing Complexity of Care: A Look at the Latest Data and Current Clinical Concepts
Credit Available:
ACCME – 1.00 AMA PRA Category 1 credit(s)™
ANCC – This activity is designated for 1.0 contact hours
Course Faculty: Scott Newsome, DO, MSCS, FAAN, FANA
With more than 20 US Food and Drug Administration-approved disease-modifying therapies (DMTs), treatment of multiple sclerosis (MS) has been—and continues to be—rapidly advancing and complex. With this wealth of treatment options comes new questions about how aggressively MS should be treated, best treatment approaches given new understanding of disease progression independent of relapse activity, the role of high-efficacy DMTs, and new treatment paradigms (eg, immune reconstitution therapy, early aggressive vs escalation therapy). This CE activity will review the currently available DMTs, including mechanisms of action, administration, benefits and risks, and current data from phase 4 studies and other sources of real-world data. New and investigational therapies also will be reviewed.
Cases in Collaborative Care: Working with Each Other and Patients
Credit Available:
ACCME – .50 AMA PRA Category 1 credit(s)™
ANCC – This activity is designated for .50 contact hours.
Course Faculty: Kathleen Costello, MS, CRNP, MSCN
The clinical course of multiple sclerosis (MS) varies substantially from individual to individual, with differences in (and not limited to) clinical manifestations, progression rate, accumulation of disability, and the degree of underlying pathology. Being able to translate clinical trial data on MS treatment into practice is frequently challenging with some patients, who oftentimes do not fit neatly into the categories and parameters defined by clinical trial inclusion and exclusion criteria. Some of the most common and key practical issues for treating patients with MS in real-world settings include selecting an initial disease-modifying therapy (DMT) and switching/escalating DMTs. Moreover, while shared decision-making is ideal in clinical practice—in a disease where the goals, preferences, and values of the patient should be paramount—patients with MS and their clinicians are often reluctant to initiate these discussions and may even be “emotionally unready” to engage with one another. As a result, many offices and clinics do not go beyond treating the disease and its manifestations to adopt multidisciplinary, patient-centric approaches to MS care—a missed opportunity to meet the individualized needs of patients with MS and improve outcomes. Through case studies, this expert-led discussion will provide practical insights into the complementary and unique roles of specialists and primary care physicians; methods to assess patient preferences, values, and goals to competently employ shared decision-making; and create individualized MS treatment plans considering the role of the MS team.