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Written by Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego I am afraid this blog has the potential to be overly controversial, so I will tread softly with my comments. Here we go: Patients often exclaim (more often it’s a complaint) during our initial encounter that their prior physician sent them home with 3 or 4 drug company pamphlets to read with instructions to call the office back and let them know which treatment they prefer. Other patients tell me that their prior physician gave them no choice and recommended a specific treatment. These approaches represent two ends of a spectrum that I find lacking. Rarely, do I hear of patients being informed of the pros and cons of available therapies, and even more rarely do I hear of any prior discussion of the short and long term goals of therapy. While it is true that we have very little useful comparative effectiveness data to help patients and physicians choose a therapy, there is data available to guide us in these decisions. So without comparing drugs let’s consider some of the factors that should go into the decision making process. All of these factors should be considered in your selection of treatment
Next, you must consider the goals of therapy and have these clearly in mind before you begin treatment. Otherwise you will never know when to consider altering your therapy in the future. Goals will also depend on where you are in the course of the disease and your prior response to therapy. With some therapies there is good evidence to support switching treatment if there is continued MRI activity 6 to 12 months after starting treatment. This is particularly well documented for interferon therapy. Of course this is only useful in monitoring patients early in the course of the disease. Later in the disease course, it is less common to see new MRI lesions or relapses even with ineffective treatment. For these patients, an appropriate goal may include maintaining the ability to walk a certain way for a certain interval of time or preventing the spread of the disease from the legs to the hands. These types of goals will also help you seek out the most appropriate rehabilitative therapies to complement pharmacological management. I hope these thoughts help you in the process of considering different treatment choices. The issues are far more numerous and nuanced than I can detail in this blog, but this framework will allow you to carry out a more thoughtful decision making process with your family and physician. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego PLEASE NOTE: The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Comments are closed.
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PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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