The biggest clinical challenges that we have in treating multiple sclerosis are 2-fold, explained June Halper, MSN, APN-C, MSCN, FAAN, chief executive officer, Consortium of Multiple Sclerosis Centers.
From a clinical perspective, what are some of the biggest management challenges with treating multiple sclerosis?
The biggest clinical challenges that we have in treating MS [multiple sclerosis] are 2-fold. One if that we have a wealth of disease-modifying therapies (DMTs)—injectables, pills, which are oral medications, and infusions. It’s very challenging for the clinicians because the patient now learns a lot about these drugs and comes in with a set of expectations, whereas the clinician may not have the same opinion about the drug or the patient’s eligibility for a certain treatment. The biggest challenge is trying to personalize the treatment the way they are doing now with cancer and other disease that can be genetically analyzed and treated appropriately. So, I think the biggest effort right now is trying to develop what we call a personalized treatment model in MS. We’ve actually, at the Consortium, developed a publication called Therapeutic Choices in MS to try and help guide the clinician. But, it’s still very challenging.
I think the most important thing we have to recognize is the patient’s voice. When I first started working in MS many years ago there was nothing patients had to decide on because we didn’t have any treatments, and today there are so many treatments and they learn about them online or from their friends or from social media. They come in asking for it, and it might not be the most appropriate drug for them and/or their insurance might not cover it. Those are the challenges we face: the patient’s expectations, the patient’s desire to become involved in the decision-making process, and then last but not least is trying to figure out if the patient goes on the drug, is it working ?
The second therapeutic clinical challenge that we have is managing symptoms. Over the years, at the late part of the 20th century, we took care of a lot of symptomatic management, like bladder and bowel and pain and spasticity. Today, there’s such a focus on modifying the disease with the DMTs, that we sort of have to back off a little bit and say, “How are you feeling? Are you have symptoms? Is your bladder bothering you? Are you having fatigue?”
That’s the second challenge: to try and get clinicians to step back and take the time to see what the quality of life is for each person. It’s not just let’s just them on a disease-modifying therapy but try to develop a total clinical package individualized for each patient. That challenge is probably not going to get easier, but it’s something we will have to deal with and will have to educate a lot of generations of clinicians, as well as patients and families.
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