Advanced Practice Clinicians' Perspective: Management of Patients on Oral Disease- Modifying Therapy for Multiple Sclerosis

Background: Nurse practitioners (NPs) and physician assistants (PAs) are vitally important in the diagnosis and management of patients with multiple sclerosis (MS). Effective treatment requires clinicians to be thoroughly knowledgeable of individual patient profiles and other key considerations when treating patients with MS in the current, rapidly evolving therapeutic landscape.

To this end, a unique panel of advanced practice clinicians (APCs; defined as NPs, PAs, and other prescribing advanced practice nurses) was assembled from 30 different clinical practice settings (academia, free-standing MS centers, collaborative private practices, and independent NP practices) in the USA and Canada. The panel addressed issues of importance to patients with MS and their caregivers regarding oral disease-modifying therapies (DMTs).

Objectives: To develop comprehensive best practice guidelines for the management of patients receiving oral DMTs, based on recommendations from an expert panel comprising APCs who specialize in treating and managing patients with MS.

Methods: The panel discussed oral DMTs available to patients with MS and identified best practice guidelines for the management of patients receiving these treatments. APC experts participated in detailed discussions of current treatments followed by interactive workshops. Using case studies and interactive sessions, APCs identified important treatment considerations, including management strategies, based on patient profiles and current stage of treatment (initiation, maintenance, or long-term treatment).

Results: The APC panel developed specific management strategies for multiple treatment approaches, emphasizing the needs of the individual patient. The panel identified the following key factors to consider when evaluating patients for the treatment of MS: disease activity; prior DMT use; child-bearing potential; general health; occupation; insurance; home life and lifestyle choices, and patient concerns. The panel used these key patient factors and characteristics of emergent DMTs to develop a detailed set of guidelines for each specific treatment stage.

Conclusions: The heterogeneity of MS requires highly individualized treatment plans. These best practice guidelines provide NPs and PAs with guidance for employing unique and effective treatment options for patients with MS who are receiving oral DMTs.