Discussions | 2 Apr 2012 Choosing Therapies May Han We currently have approximately a dozen disease modifying therapies. What is the rationale behind choice of therapy for your MS patients? How would you monitor response to therapy? Is MRI imaging sufficient? Comment2 commentsRecommendBookmarkWatch Comments Folks, The goal of immunological treatment for MS is currently evolving. It is shifting from the initial goal of slowing the progression of disability to acheiving a "disease activity free state" where possible. This means treating a patient such that they are not having relapses, have no new lesions forming on MRI and no progression of disability. This is not possible in all patients yet, but is achievable, apparently, in a some patients on the newer highly effective therapies. More recently, we are also seeing evidence in certain subsets of patients that with optimal use of certain therapies, that the patients actually improve in function over a matter of 1 to 2 years. The group most likely to achieve this response to therapy appear to be in early phase disease where fatigue, depression and cognitive complaints are the main disabling effects of MS. With several of the newer agents, there is evidence of improvement over time with these patients. We need to accelerate research in this area to determine which therapy gives each patient the best chance to not only achieve a "disease activity free state" but, possibly, recover function. Thank you for your encouraging words, however is it possible to be more specific in terms of which treatments are you talking about? For example, I was on Tysabri for 24 months and it went very well but I had to stop using it because it began giving me liver problems.