‘An important milestone’: New MS guidelines published

Brand new recommendations for managing multiple sclerosis (MS) have been released, aimed at helping health professionals including GPs put in place evolving options for treatment of the disease.
 
Published this week in the Medical Journal of Australia, the first consensus statement for Australian and New Zealand includes 80 recommendations.
 
While the disease has no cure, researchers describe early intervention with disease-modifying therapy (DMT) as ‘essential to reduce relapses and disability’.
 
According to Monash University, which led the process for compiling the guidelines, the onset, progression and symptoms of MS can vary widely between individuals.
 
The statement’s senior author Associate Professor Mastura Monif, a neurologist and researcher at the Monash University School of Translational Medicine and head of Alfred Health’s Neuroimmunology Service, said therapies have evolved significantly in recent years.
 
‘New disease-modifying therapies are more effective and better tolerated,’ she said.
 
‘But it’s a much more complex treatment landscape than it was 20 years ago, and there is new evidence being generated all the time on many aspects of the disease.
 
‘It is really important that the approach used is focused on both the effectiveness and safety for the individual so they can get the best possible outcome.’
 
The guidelines are divided into two parts, with Part 1 covering recommendations for DMT counselling and selection, pre-DMT assessments, monitoring disease activity, switching DMT, and discontinuing DMT.
 
Further recommendations in Part 2 include risk mitigation strategies during treatment, managing DMT in special situations such as pregnancy, postpartum, breastfeeding, active infection including COVID-19, and malignancy, as well as general lifestyle measures, acute MS relapses, and symptomatic treatments for MS.
 
According to Monash University, the Therapeutic Goods Administration adopted an international MS guideline in 2009, which was updated most recently in 2015.
 
The new guidelines involved more than 30 collaborators as part of an Australian and New Zealand Association of Neurologists’ working group.

Their recommendations were also reviewed by a panel, including people with MS, nurses, physiotherapists, psychologists, an MS support group, a non-profit MS research and advocacy group, an infectious diseases doctor, an immunologist and a GP.
 
MS Australia Chief Executive Rohan Greenland describes the guidelines as ‘an important milestone in MS care in Australia’, saying they provide ‘a clear and ready reference to best-practice evidence and expert consensus’.
 
The guidelines highlight the important role of GPs in managing MS, which affects more than 33,000 people in Australia.
 
‘Communication between neurologists and general practitioners is crucial in caring for people with MS,’ the statement reads. 
 
‘General practitioners can assist with risk mitigation on [disease-modifying therapies], such as immunisations and routine cancer screening, as well as general health measures, such as assisting with smoking cessation, maintenance of a healthy diet and exercise, and monitoring cardiovascular health.’ 
 
A report published by the Australian Institute of Health and Welfare in 2022 found that MS accounted for the highest health system spending of any neurological condition in Australia, with around $21,000 per case.
 
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