Treatment Recommendations for Men with Multiple Sclerosis

Initial Treatment Approach

The American Academy of Neurology recommends that treatment selection should be based on MS subtype, disease activity, and patient characteristics 1
High-efficacy DMTs are more effective when initiated early in the disease course, according to the National Multiple Sclerosis Society 1, 2
Current evidence favors early escalation and induction treatment strategies over traditional stepped approaches, as stated by the Multiple Sclerosis Association of America 1

For patients with markers of aggressive disease, high-efficacy DMTs should be considered as first-line treatment, recommends the National Institute of Neurological Disorders and Stroke 1
In patients with highly active MS that fails to respond to high-efficacy DMTs, AHSCT should be considered as an appropriate escalation therapy, according to the European Committee for Treatment and Research in Multiple Sclerosis 3, 4
AHSCT is most suitable for patients who are younger than 45 years of age, have disease duration less than 10 years, have high focal inflammation, have EDSS score less than 4.0, and have relapsing-remitting MS, as recommended by the International MS Society 3, 5

For primary progressive MS, ocrelizumab is indicated as a specific treatment, though its efficacy is primarily limited to slowing disability progression, states the American Academy of Neurology 1
AHSCT should only be considered for young individuals with early progressive MS who have a short disease duration and documented clinical and radiological evidence of inflammatory disease, recommends the European Academy of Neurology 4

MRI follow-up should be conducted within 3-12 months depending on disease characteristics and treatment, according to the Radiological Society of North America 6
For patients with incomplete recovery after relapses, evaluate for DMT adjustment, recommends the Multiple Sclerosis International Federation 6

AHSCT should only be considered as first-line therapy for individuals with rapidly evolving, severe MS with poor prognosis, and should be offered as part of a clinical trial or observational study, states the National Institutes of Health 4
Assessment for AHSCT requires detailed neurological evaluation, disease history, disability status, and MRI examination, recommends the European Society for Medical Oncology 7, 8

Pseudoatrophy effect can cause excessive decrease in brain volume within the first 6-12 months of treatment due to resolution of inflammation, which should not be mistaken for disease progression, warns the American Academy of Neurology 2
Inappropriate washout periods between different DMTs can lead to complications from carryover effects, cautions the Multiple Sclerosis Association of America 2

Patients under 45 years with disease duration less than 10 years are optimal candidates for more intensive treatments, including AHSCT if indicated, recommends the National Multiple Sclerosis Society 1
For patients over 55 years with disease duration greater than 20 years and absence of focal inflammation, AHSCT is not recommended and more conservative approaches may be required, states the American Geriatrics Society 1