InforMS: Summer 2018

InforMSSummer2018 coverThe Tipping Point

A focus on late-life outcomes and minimizing disability would be a fundamental shift in how the world treats MS. When will we reach the tipping point?




The Tipping Point

By Peter Broderick | There’s a fundamental difference in opinion in modern MS treatment.

On one hand, we have a treatment strategy defined by what amounts to a “wait and see” approach. In this model, generally speaking, MS is treated as symptoms become evident. When we’re sure someone has MS – usually after confirming with long periods of observation, MRIs and other tests – treatment starts with the aim of mitigating the day to day effects of MS on the patient.

In contrast to that is a newer model, focused on early, effective and aggressive treatment of the disease. The strategy starts with identifying MS as early as possible – in many cases, even before significant symptoms are apparent. Patients are treated with the latest and most effective MS drugs at the very earliest signs of MS, in an effort to slow or even stop the disease before it has the opportunity to do much lasting damage.

Why the disparity? Well, that’s a complicated question. But the field of MS treatment may be on its way to tipping point that will fundamentally change how MS is treated around the world.

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Patient-Reported Outcomes

Medical appointments tend to be too short to address all our concerns and care does not always feel patient-centered. In an effort to reme-dy these common experiences and give patients a voice, the Rocky Mountain MS Center at University of Colorado (RMMSC at CU) employs a unique program: Patient Reported Outcomes (PROs).

The RMMSC at CU invites all patients with appointments to complete questionnaires—available on iPads in the clinic and sent out by email — about their quality of life. This self-assessment program helps providers recognize quality-of-life changes over time, making patients’ concerns central to their ongoing care. The program also helps providers to recog-nize and analyze similarities or differences within the patient population as a whole.

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DISCO MS: When is it Time to Stop?

By Kerri Cechovic | One of the most diffi cult decisions for someone who’s been living with MS for a long time is whether or not to discontinue their treatment with disease modifying therapies (DMTs). Is there a point when MS “slows down” and DMTs just aren’t as helpful as they had been earlier in a patient’s life? To date, there’s been no research into this possibility, but the Rocky Mountain MS Center at University of Colorado (RMMSC at CU) is spearheading an eff ort to get some answers.

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Early Risk Factors in MS – RISE MS Study

By Kerri Cechovic | As we develop treatment strategies that rely on early diagnosis, it’s more important than ever that we identify MS as quickly as possible — and that means watching for common factors that we see in early MS, and looking at things that may be reliable indicators of what could develop into the disease.

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Step Edits: Insurance-Dictated Choices Put Some MS Patients at Risk

By Thomas Stewart, M.S., J.D., PA-C | This issue of InforMS describes the serious eff orts of expert physicians to identify the best strategies to treat people with multiple sclerosis. Unfortunately, however, there is another critical decision maker that has been injected into the process: health insurance companies. As many people with MS know, the drug that a doctor and a patient agree upon may not be one that your insurer will cover. Th e health insurance company may have determined that it will only pay for a diff erent drug, at least at fi rst. Given the extraordinary expenses involved, the drug that your insurance company has determined that it will pay for will very likely trump all other considerations. In eff ect, many people are treated according to their health insurer’s preference rather than according to the decision that they arrive at jointly with their physicians.

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