Multiple sclerosis
Also known as: demyelinating disease · MS
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Practice Guideline Recommendations: Disease-modifying Therapies for Adults with Multiple Sclerosis
American Academy of Neurology (AAN) · 2018 · 2018 (reaffirmed 2024)
The AAN's evidence-based recommendations on disease-modifying therapy for adults with multiple sclerosis, covering when to start treatment, when and how to switch after breakthrough disease, and considerations around stopping therapy. It is paired with a separate systematic review of DMT efficacy and safety. Published in Neurology in 2018, endorsed by several MS organisations, and reaffirmed in October 2024.
- Contains recommendations grouped around starting, switching, and stopping disease-modifying therapy. source
- Reaffirmed by the AAN on 19 October 2024 and endorsed by the Consortium of MS Centers, MS Association of America, and National MS Society. source
- Accompanied by a companion AAN systematic review of disease-modifying therapies for adults with MS. source
ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis
European Committee of Treatment and Research in Multiple Sclerosis (ECTRIMS) and European Academy of Neurology (EAN) · 2018
The joint European guideline on drug treatment of multiple sclerosis, developed with GRADE methodology around ten clinical questions. It addresses treatment efficacy, how to define and detect suboptimal treatment response, what to do when response is inadequate, safety monitoring, and treatment strategy around pregnancy. Published in the European Journal of Neurology in 2018; an ECTRIMS/EAN update was still in development as of 2025.
US vs EU key differences
- Unusually, currency matches: both the AAN practice guideline and the ECTRIMS/EAN guideline were published in 2018, so neither side has a clear recency advantage. source
- Methodology and output size differ: ECTRIMS/EAN used GRADE and produced 20 recommendations across 10 clinical questions after three consensus rounds, while the AAN used an Institute of Medicine-compliant process with modified Delphi consensus to produce 30 recommendations (17 on starting, 10 on switching, 3 on stopping disease-modifying therapy). source
- The European guideline sets a concrete MRI monitoring schedule: a standardised reference brain MRI usually within 6 months of starting a disease-modifying drug, compared against a further scan typically 12 months after treatment start, with new or enlarging T2 lesions as the preferred measure, plus an annual MRI for safety in patients at low PML risk. source
- Regulatory anchoring differs: the ECTRIMS/EAN guideline explicitly limits itself to disease-modifying drugs approved by the European Medicines Agency at the time of publication, and names interferon or glatiramer acetate as initial options for active relapsing-remitting disease. source
What changed recently
- US2002 → 2018 (reaffirmed 2024)2018-04-23
The AAN retired its 2002 disease-modifying therapy guideline in April 2018 and replaced it with this document, which covers the far larger modern DMT armamentarium and, unlike its predecessor, gives explicit recommendations on starting therapy after a first demyelinating event with MRI lesions, on monitoring adherence and tolerability, on switching agents when breakthrough disease activity occurs, and on when discontinuation may be discussed.
source ↗curation confidence 90%
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