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Multiple Sclerosis, Neuroimmunology CE/CME accredited

A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

Individualizing long-term treatment and care in active MS: How are therapeutic sequencing options evolving to address unmet needs?

  • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Portuguese, Spanish.
  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Evaluate factors guiding the use of high-efficacy DMTs in the management of active MS
  • Summarize current approaches and safety considerations relating to DMT switching and sequencing in MS
  • Appraise the use of DMTs in women of child-bearing age with MS, including considerations for family planning and implications during pregnancy and beyond

In this activity, two experts in MS explore the evolving practicalities of therapeutic sequencing options in MS. They discuss when to consider high-efficacy DMTs, how to optimize a switch in DMT, and practical considerations surrounding the use of DMTs in women of child-bearing age living with MS.

The discussion is guided by pre-canvassed questions provided by healthcare professionals involved in the management of people living with MS.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

General neurologists and MS specialists, including specialist nurses, involved in the management of people with MS.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Dr Ruth Dobson discloses: Advisory board or panel fees from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz. Grants/research support from Biogen, Celgene and Merck KGaA. Other financial or material support (royalties, patent, etc.) from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz.

Dr Ide Smets discloses: Speakers bureau fees from EPG Health (relationship terminated).

Content reviewer

John Ciotti, MD discloses: Advisory Board or Panel fees from EMD Serono, Genentech, Janssen, Novartis (All Relationships Terminated).

Touch Medical Directors

Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 12 June 2023. Date credits expire: 12 June 2024.

If you have any questions regarding credit please contact

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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  • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Portuguese, Spanish.
  • Downloads including slides are available for this activity in the Toolkit

Topics covered in this activity

Multiple Sclerosis / Neuroimmunology
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Individualizing long-term treatment and care in active MS: How are therapeutic sequencing options evolving to address unmet needs?
1.0 CE/CME credit

Question 1/5
You are managing your patient who has recently been diagnosed with MS. How would you proceed when deciding if your patient may benefit from a high-efficacy DMT approach?

DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MRZ, measles, rubella and varicella zoster virus antibodies; MS, multiple sclerosis.

The ECTRIMS/EAN guidelines on the pharmacological treatment of people with MS state that, when starting a new drug, clinicians should take into account that the greater the disease activity (clinical and MRI), the higher the need for high-efficacy DMTs.1 The 2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI in patients with MS recommend the use of MRI at diagnosis to predict future disease activity and, to some extent, disease progression.2


CMSC, Consortium of Multiple Sclerosis Centres; DMT, disease-modifying therapy; EAN, European Academy of Neurology; ECTRIMS, European Committee for Treatment and Research in Multiple Sclerosis; MAGNIMS, Magnetic Resonance Imaging in MS; MRI, magnetic resonance imaging; MS, multiple sclerosis; NAIMS, North American Imaging in MS Cooperative.


  1. Montalban X, et al. Mult Scler. 2018;24:96–120.
  2. Wattjes MP, et al. Lancet Neurol. 2021;20:653–70.
Question 2/5
Which of the following is a criterion for switching DMT in patients with MS who have been using a DMT long enough for the treatment to take full effect?

DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MS, multiple sclerosis.

European consensus publications define treatment failure, where a patient may have their treatment switched, as ≥3 new T2 lesions and 1 relapse, or ≥2 relapses (independent of MRI activity) in the last 6 to 12 months. American consensus guidelines recommend the criteria of ≥1 relapse, ≥2 new MRI-detected lesions, or increase in disability over 1 year.


MRI, magnetic resonance imaging.


Wiendl H, et al. Ther Adv Neurol Disord. 2021;14:17562864211039648.

Question 3/5
You are treating your patient with MS with natalizumab. Which of the following monitoring strategies would you implement to help decide if your patient needed to switch to another DMT?

DMT, disease-modifying therapy; JCV, John Cunningham virus; MS, multiple sclerosis.

Testing for serum anti-JCV antibodies prior to initiating, and every 6 months following, is recommended in patients receiving treatment with natalizumab. If JCV granule cell neuronopathy is suspected, further use of natalizumab should be suspended until progressive multifocal leukoencephalopathy is evaluated and, if confirmed, discontinued.


JCV, John Cunningham virus.


EMA. Natalizumab SmPC. Available at: (accessed 15 May 2023).

Question 4/5
Exposure to anti-CD20 monoclonal antibodies in patients with MS during pregnancy has which of the following reported outcomes?

MS, multiple sclerosis.

Real-world data suggest that exposure to anti-CD20 monoclonal antibodies during pregnancy in women with MS led to a probable risk for reduced B-cell count in neonates.


MS, multiple sclerosis.


Krysko KM, et al. Lancet Neurol. 2023;22:350–66.

Question 5/5
You are managing your patient with MS who discontinued their DMT during pregnancy and wishes to breastfeed, but whose disease activity suggests they would benefit from treatment resumption. Which of the following factors do you need to consider?

DMT, disease-modifying therapy; IFN, interferon; MS, multiple sclerosis.

DMTs can be excreted into breastmilk at varying rates dependent on factors such as molecular weight, plasma protein binding, lipophilicity and stage of lactogenesis. The safety of DMT use varies during breastfeeding. Approval in Europe has been given for use of interferon betas and glatiramer acetate by women with MS during breastfeeding. Ofatumumab may be used during breastfeeding if clinically needed.


DMT, disease-modifying therapy; MS, multiple sclerosis.


Krysko KM, et al. Lancet Neurol. 2022;22:350–66.

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