Two leading experts took to the stage during ANZAN ASM to debate a controversial topic in neurology – should high-expense high potency MS therapy be used first-line in patients with MS?
![](https://thelimbic.com/wordpress/wp-content/uploads/2019/05/458758picture.jpg)
Dr Tomas Kalincik
Taking on the ‘yes’ side of the debate Associate Professor Tomas Kalincik from the Royal Melbourne Hospital told delegates that recent statistics showed the number of people living with MS in Australia increased by just over 20% from 21,283 in 2010 to 25,607 in 2017, with a total cost to society of $1.75 billion.
“That cost increases in Australia from roughly $30K per year to close to $120K per person per year with increasing disability…people with more advanced disease cost us more to look after,” he told delegates.
“In the absence of therapies routinely available to clinicians, MS is a one way street. We need to prevent the disability, and its associated costs, rather than wait for the disability to develop… because there is no way back,” he stressed.
Evidence showed that high potency treatments were effective at preventing disability in patients.
For example, a trial published in JAMA earlier this year by the MSBase Study Group showed that initial treatment of patients with relapsing-remitting MS with disease-modifying therapies fingolimod, natalizumab, or alemtuzumab was associated with a 34% lower risk of conversion to secondary progressive MS compared with interferon beta or glatiramer acetate therapy.
“This [figure] is not a marginal difference,” Professor Kalincik noted.
According to Professor Kalincik the crux of the conversation was how to identify the patient with severe disease who would require an aggressive approach to treatment.
“Unfortunately we haven’t been very successful at isolating that group of patients who would do fine on low efficacy therapy over the long-term,” he said.
He noted that it was not only the dichotomy of high efficacy vs low efficacy that required thought but also the timing of treatment.