Mark S. Freedman

Multiple Sclerosis Research Unit, The Ottawa Hospital, Ottawa, Canada

The “window of opportunity” for treatment is different for each patient with MS. There are now many possible agents to offer individuals with relapsing forms of MS, but there is still no validated way of finding the most suitable agent for any one patient other than a “hit-and-miss” approach.It is hoped that some biomarkers will soon identify therapies that might be ineffective in certain individuals and therefore avoided so as not to waste precious treatment time. Somewhat empirically, therefore, we must choose the agent most appropriate to where we feel a patient lies within the “window” and monitor treatment response accordingly. Although, with the “right” treatment approach, it might be possible to keep patients 100% disease activity-free today, given that no treatment is a “cure”: some disease activity may be inevitable.

Using models that place weight on the quantity and quality of events occurring while tolerating and adhering to a particular therapy, it might be possible now to determine when it might be best to stop a particular treatment, as well as provide guidance as to what should be tried next. These types of treatment algorithms are evolving as we acquire and appreciate the benefits (and risks) of newer treatments.