Counseling Points Multiple Sclerosis - Winter 2015 - 14

Counseling Points™
Advising Patients About Disease-Modifying Therapy Selection and Switching

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PLEASE SELECT THE BEST ANSWER
c. patients may need to start on an agent in the payer's
"preferred" group or tier, and demonstrate failure on that
agent before a switch to a second-tier agent is authorized
d. the prescribing physician has the final say when it comes to
selection of a DMT

1. Research on patterns of switching in multiple sclerosis
(MS) shows that most patients who switch:

a. have a lapse (period of no treatment) between therapies,
which may increase risk of relapse
b. transition from one therapy to the next with no break in
between
c. are advised by their physicians to have a "washout period"
of 3 to 5 months between therapies
d. wait until they have a relapse of MS before starting a new
therapy

7. A patient in your practice has requested to change to a
different DMT because he feels the therapy is not working for him. He has been using this particular agent for 3
months. The most appropriate response would be:

a. tell him he should wait a little longer to see if the drug is
working or not
b. conduct an examination to detect possible clinical
worsening, nonadherence, or need for additional evaluation
c. assume that the patient has not been taking the drug as
directed
d. make arrangements to switch therapies to the agent the
patient has requested

2. North American Research Committee on Multiple Sclerosis (NARCOMS) registry data show that switches in
therapy are usually initiated by:

a. the person with MS
b. the physician
c. the person with MS or the physician at equal rates
d. the insurer or third-party payer
3. True or False: According to the recent NARCOMS survey on switching therapies, most people with MS who
decided to switch did so because of something they read
on the Internet.

8. A single acute attack of MS in the course of a year while a
patient is on DMT should warrant:

a. a change to a different therapy
b. a change to a more aggressive therapy
c. no change; one relapse is realistic
d. an increased level of monitoring and consideration of a
switch

a. True
b. False
4. When discussing an initial disease-modifying therapy
(DMT), the faculty recommends that patients be given:

a. information about the one DMT that seems best for that
person's medical history and lifestyle
b. comprehensive information about all of the approved MS
DMTs
c. information about 2 or 3 therapies to take home and
consider before making a decision
d. a choice between a few DMTs for a decision that same day,
to ensure that the person starts therapy immediately

9. One of your patients appears to be having signs of worsening disease. You suggest a switch, but she says she feels fine
and wants to stay on her current therapy. The faculty recommends:

a. keeping her on her current therapy; if she's happy, she's more
likely to take it
b. keeping her on the therapy and suggesting a follow-up in 6
months to see if the worsening condition has continued
c. showing the patient an MRI or other evidence of worsening
disease to support the discussion about switching
d. asking the physician to step in and talk some sense into the
patient

5. The concept of shared decision-making in MS is important because:

a. people who have a say in therapeutic decisions are more
likely to stay on a DMT
b. patients benefit from the healthcare professional's insight
when making an informed decision
c. patients' values, risk tolerance, and goals for treatment
should be considered
d. all of the above

10. The recent report by the Agency for Healthcare Research
and Quality (AHRQ) on discontinuation of MS therapies
after 2 years was:

a. contested by several large MS organizations as being
potentially misleading
b. jointly developed by the American Academy of Neurology
(AAN) and Consortium of MS Centers (CMSC)
c. considered the definitive statement about how long patients
should stay on therapy
d. republished by the AAN and CMSC as a clinical practice
guideline

6. When advising patients about the role of reimbursement
in DMT selection, it is generally accurate to state that:

a. if a therapy is deemed medically appropriate for the patient,
most payers will cover its cost
b. payers are required to provide coverage for all FDAapproved drugs for MS
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Counseling Points Multiple Sclerosis - Winter 2015

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