Page 4 - Gulf Consensus

TREATMENT RECOMMENDATIONS

Table 1. Consensus recommendations on the use of DMDs in people with RRMS according to disease
activity and previous treatment status.

Treatment recommendation
Disease activity at
first presentation No prior DMD 1 prior DMD 2 prior DMD
(1 -line) (2 -line) (3 -line)
nd
st
rd
Active MS without Beta Interferon Cladribine tablets Cladribine tablets
indicators of Glatiramer acetate Dimethyl fumarate* Natalizumab
poor prognosis Teriflunomide Fingolimod Fingolimod
Dimethyl fumarate Natalizumab b Ocrelizumab
Alemtuzumab b

Highly active MS Cladribine tablets Cladribine tablets Cladribine tablets
Natalizumab Natalizumab Natalizumab
Fingolimod Ocrelizumab Ocrelizumab
Ocrelizumab Alemtuzumab a Alemtuzumab
Dimethyl fumarate a Fingolimod a

Rapidly evolving Cladribine tablets Natalizumab Natalizumab
severe MS Natalizumab Ocrelizumab Alemtuzumab
Ocrelizumab Alemtuzumab a Ocrelizumab
Fingolimod a Cladribine tablets a

All recommendations were achieved via a high level of expert consensus (at least seven out of 10 experts agreed), except where
indicated as a moderate consensus (between four and six experts agreed) or low consensus (three experts or fewer agreed). DMD:
b
disease-modifying drug.
*DMF may be considered as second-line therapy in patients without poor prognostic indicators as there is
some evidence for greater efficacy compared with other platform therapies.

The choice of third-line treatment is not evidence based due to the lack of well
designed clinical trials based on patients who have received two DMDs previously. These
recommendations are therefore based on the experience and judgement of the authors.