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Sunday, February 11, 2018

Aaron Boster, MD Video: I don't agree with the Escalation Model of treating Multiple Sclerosis

Published on Feb 10, 2018

Aaron Boster, MD : I don't agree with the Escalation Model of treating Multiple Sclerosis
The most common way of treating a PwMS is to use the "escalation model" which can be summarized as starting someone with MS on a "low efficacy, high safety" drug and then “closely monitoring”. If they patient does well, then all is dandy. If it doesn't work out, then the clinician will "upgrade" or "escalate" to a medicine that is thought to have higher efficacy, but a less attractive safety profile. Sounds great! perfect balance between risk and benefit... I strongly disagree, for 3 reasons: 1. "it doesn't work out" means we allowed the PwMS to accrue BRAIN DAMAGE on their low efficacy drug. THAT'S NOT OK! 2. therapeutic lag: allowing early inflammatory damage while on a low efficacy DMT sets up accelerated brain volume loss down the road. Switching later to a high efficacy drug isn't able to reverse that! 3. therapeutic inertia: The escalation model assumes that we can pick up all indicators of disease activity AND we will act on them. This is simply not the case, as many aspects of disease activity can be missed with infrequent clinic visits, insensitive testing measures, infrequent MRI scans, etc. For these reasons I feel we must scrutinize the "escalation model" heavily. For these reasons I would MUCH rather start a PwMS on a highly effective medication (with a risk profile that individual PwMS is comfortable with) from the beginning. Thank you for watching. Please include your comments and questions below


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