Multiple Sclerosis Decision Model (MSDM): Development of a Multifactorial Model to Monitor Treatment Response and Disease Course in Relapsing Remitting Multiple Sclerosis

The introduction of new and potent medications for the treatment of relapsing-remitting multiple sclerosis (MS) has increased the desire for therapeutic success. The mere reduction of the relapse rate is not sufficient anymore. Instead, the goal should be the absence of clinically relevant disease activity. However, there is no generally accepted definition so far. A panel of German experts has proposed that achievement of this therapeutic aim should include - beside relapse rate, disability progression and MRI parameters - neuropsychological tests and quality of life measures. A specification is required as to how this can be measured in everyday practice. In order to standardise the investigations in an economic and schematic way, a multifactorial model (Multiple Sclerosis Decision Model, MSDM) is proposed that includes the domains relapse, disability progression, MRI, and neuropsychology. The proposed tests reflect the complexity of the disease even in the early stages when scales like the EDSS (Expanded Disability Status Scale) are not able to discriminate low levels of progression. The MSDM is intended to support early treatment decisions and uncover treatment failures early on. Prospective investigations are required to prove that such a disease monitoring does indeed lead to an early and effective disease stabilisation.