Multiple Sclerosis Treatment Guidelines

Initial Treatment and Disease Management

The American Academy of Neurology recommends that when patients experience breakthrough disease activity on first-line therapy, escalate to natalizumab if JC virus antibody-negative, or consider alemtuzumab, ocrelizumab, or fingolimod 1
For aggressive relapsing-remitting MS refractory to high-efficacy disease-modifying therapies, Autologous Haematopoietic Stem Cell Transplantation (AHSCT) using intermediate-intensity conditioning is recommended as it achieves superior disease control compared to continued DMT escalation 2, 3, 4, 1

The National Multiple Sclerosis Society suggests that AHSCT eligibility criteria include age 18-55 years, EDSS score 0.0-6.0, active disease, and failed standard or high-efficacy DMT for ≥6 months 3
The European Committee for Treatment and Research in Multiple Sclerosis recommends that pre-AHSCT requirements include comprehensive screening, such as liver function, bone marrow, viral profiles, and cardiac assessment 1, 4, 3

The American College of Radiology recommends that standard MRI surveillance include baseline and follow-up scans with consistent protocols to facilitate comparison 1
The Multiple Sclerosis International Federation suggests that rehabilitation should begin immediately post-AHSCT to exploit the brain's reorganizational capacity during complete inflammatory suppression, with a phased approach including pre-habilitation, early mobilization, intensive outpatient rehabilitation, and maintenance rehabilitation 4

The National Institute of Neurological Disorders and Stroke advises against unnecessarily prolonging DMT withdrawal before AHSCT, as this increases relapse risk, and against underestimating carryover effects of alemtuzumab before AHSCT 1