Treatment algorithms of relapsing multiple sclerosis: an exploration based on the available disease-modifying therapies in China

Jun Guo; Jiayong Wu; Lihua Wang; Hongbo Liu; Xiaomu Wu; Huan Yang; Wenyu Li; Honghao Wang; Bitao Bu; Chunsheng Yang; Hongyu Zhou; Shougang Guo; Yinan Zhao; Zhanhang Wang; Chunyang Li; De-Cai Tian; Sheng Chen; Huiru Xue; Yanlin Zhang; Yongfeng Xu; Hui Liang; Zhe Wu; Yu Zhang; Qiang Dong; Jiawei Wang; Chao Quan

doi:10.1177/17562864241239117

Treatment algorithms of relapsing multiple sclerosis: an exploration based on the available disease-modifying therapies in China

Ther Adv Neurol Disord. 2024 Apr 13:17:17562864241239117. doi: 10.1177/17562864241239117. eCollection 2024.

Authors

Jun Guo¹, Jiayong Wu², Lihua Wang³, Hongbo Liu⁴, Xiaomu Wu⁵, Huan Yang⁶, Wenyu Li⁷, Honghao Wang⁸, Bitao Bu⁹, Chunsheng Yang¹⁰, Hongyu Zhou¹¹, Shougang Guo¹², Yinan Zhao¹³, Zhanhang Wang¹⁴, Chunyang Li¹⁵, De-Cai Tian¹⁶, Sheng Chen¹⁷, Huiru Xue¹⁸, Yanlin Zhang¹⁹, Yongfeng Xu²⁰, Hui Liang²¹, Zhe Wu²², Yu Zhang²³, Qiang Dong^{24

25}, Jiawei Wang²⁶, Chao Quan^{27

25}

Affiliations

¹ Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China.
² Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
³ Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China.
⁴ Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁵ Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁶ Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
⁷ Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁸ Department of Neurology, Guangzhou First People's Hospital, Guangzhou, China.
⁹ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.
¹¹ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
¹² Department of Neurology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China.
¹³ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹⁴ Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China.
¹⁵ Department of Neurology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
¹⁶ Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁸ Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
¹⁹ Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
²⁰ Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
²¹ Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
²² Department of Neurology, The First Hospital of China Medical University, Shenyang, China.
²³ Biogen, Shanghai, China.
²⁴ Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
²⁵ National Center for Neurological Disorders, Shanghai, China.
²⁶ Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
²⁷ Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12, Middle Wulumuqi Road, Shanghai 200040, China.

Abstract

Multiple sclerosis (MS) was defined as a rare disease in China due to its low prevalence. For a long time, interferon β was the only approved disease-modifying therapy (DMT). Since the first oral DMT was approved in 2018, DMT approval accelerated, and seven DMTs were approved within 5 years. With an increasing number of DMTs being prescribed in clinical practice, it is necessary to discuss the standardized MS treatment algorithms depending on the disease activity and DMT availability. In this review paper, more than 20 Chinese experts in MS have reviewed the therapeutic progress of MS in China and worldwide and discussed algorithms for treating relapsing MS (RMS) based on the available DMTs in China, providing insights for establishing the standardized RMS treatment algorithms in this country.

Keywords: China; disease-modifying therapy; relapsing multiple sclerosis; treatment algorithm.

Plain language summary

Treatment algorithms of relapsing multiple sclerosis in China In this review paper, more than 20 Chinese experts in MS have reviewed the therapeutic progress of MS in China and worldwide and discussed algorithms for treating relapsing MS (RMS) based on the available DMTs in China, providing insights for establishing the standardized RMS treatment algorithms in this country: 1) CIS and RRMS account for more than 90% of the MS patients and most of them are mild to moderate; 2) MS patients should initiate DMT treatments as soon as the disease has been diagnosed in order to reduce the risk of disease progression; 3) Patients who have been diagnosed with MS should start treatment with fundamental DMTs unless the disease course has been highly active; 4) MAGNIMS score may be a suitable and simplified assessment tool for measuring treatment response to DMTs; 5) Patients treated with corticosteroids and NSIS should be switched to the standardized DMT treatment during remission in accordance with disease activity.

Publication types

Review