54 msfocusmagazine.org Medicine & Research The year 2017 was an exciting time in the world of multiple sclerosis. We are not yet at the point where we have a cure for MS, but there have been several big developments. We now have a treatment for primary progressive MS, our approach to disease management has shifted, we have achieved advancements in neural repair, and we now have a better understanding of stem cell treatments. Let’s take a closer look at some of these updates. Ocrevus Spring 2017 saw the arrival of the first FDA-approved agent for primary progressive MS: Ocrevus (ocrelizumab). Primary progressive MS affects about 10 percent of the MS community and does not follow many of the rules we associate with MS. In contrast to the relapsing-remitting course, primary progressive is more common in men and starts later in life. Clinical studies of Ocrevus in primary progressive showed that it slowed the progression of this form of MS and is a much-needed addition to our clinical weaponry in the fight against MS. Ocrevus is also approved for relapsing-remitting MS. It is given as a twice-yearly intravenous medication and appears to have a good safety profile. Disease Management The past year we witnessed a shift in the way we think about using our treatment options in the management of MS. Each of the FDA-approved treatment options can be scored based upon its convenience, safety, and effectiveness. It is widely accepted that treatment should begin as soon as possible for individuals with MS. Questions remain, however, about which treatment is best for an individual. Many healthcare providers follow a “step therapy” approach to selecting treatment. In this treatment paradigm, one selects a treatment with the best safety profile and then moves to other treatment options only if the first option is ineffective. This might mean picking a drug like Copaxone or Rebif, with well-established safety profiles, and then only considering a move to something such as Tysabri if a person had breakthrough relapses, progression of disability, or new lesions on MRI. In contrast, there is growing acceptance of using more effective therapies, with a higher risk for potential side effects, earlier in the course of MS. This might mean going to Tysabri or Ocrevus as first-line treatments rather than saving them for later. As with any treatment decision, the risks and benefits need to be considered and discussed openly. 2017-A Year in Review By Dr. Ben Thrower and Jacqueline F. Rosenthal