A review article investigating variation in the treatment of MS is calling for a European treatment guideline, to encourage the best possible clinical practice and improve outcomes for people with MS.1
In Europe, there is the potential for MS to be better managed than ever before. Using the advanced 2010 criteria for diagnosis, MS can now be identified earlier in the disease course than was previously possible. Furthermore, several new treatments, including three oral therapies, have been approved by the European Medicines Agency since 2010, widening the options available.
Despite this progress, Professor Marziniak and colleagues highlight that national and local guidelines, reimbursement policies and cultural factors result in differences across Europe regarding which treatments can be prescribed and when treatment is initiated, switched or escalated. For example, in Germany, Denmark, France and Italy, intolerable side effects are sufficient grounds to switch treatments. In several other countries, however, health policy dictates that treatment should not be switched just because of poor tolerability.
The authors of the review conclude that a pan-European treatment guideline could be used to inform, and be informed by, national policies, to help align and disseminate best clinical practice.
In an editorial about this review, Professor Giovannoni further highlights inconsistencies in the prescribing of licensed MS disease-modifying therapies across Europe (for details, see section 5 of Brain health: time matters in multiple sclerosis). Wide variation is not surprising, according to Professor Giovannoni, and is influenced by many factors – in particular, the speed at which different groups of people welcome innovation.2 A European MS guideline would need widespread and timely support, not just from prescribers, but also from payers and policy makers.
1. Marziniak M, Ghorab K, Kozubski W et al. Variations in multiple sclerosis practice within Europe – is it time for a new treatment guideline? Mult Scler Relat Disord. 2016;8:35–44.
2. Giovannoni G. Why do you have to be lucky to get the MS treatment you deserve? Mult Scler Relat Disord. 2016;8:A3–4.