Patricia K. Coyle, MD: Starting and Stopping Multiple Sclerosis Treatment

“Have they done so well because of the DMT they’re on, or have they done so well because perhaps this was a milder form of MS and they would have done well without treatment? Right now, we don’t have a way to cull those [questions] apart.”

An ongoing discussion in the multiple sclerosis (MS) scientific community surrounds the somewhat controversial decision to halt therapy in patients with MS, particularly those with relapsing disease as they age. Another focuses on the need to initiate earlier treatment in MS, with some suggesting that despite clear evidence of benefit in the literature, the translation to clinical practice is still not widespread enough.

In a conversation with NeurologyLive, Patricia K. Coyle, MD, professor and interim chair, department of neurology, and director, MS Comprehensive Care Center, Stony Brook University, detailed her perspective on these arguments and what the community has still to learn about making these treatment decisions. She explained that while the decision to stop treatment still requires new information, the jury is out on the need to initiate treatment as soon as possible.

Coyle spoke to this early-treatment approach in patients with early disease, including those with clinically isolated syndrome (CIS). She explained the patient point of view in getting the diagnosis and the need to communicate the importance of early treatment in this population—even in light of patient pushback.