A 45-year-old woman with relapsing-remitting multiple sclerosis has had two confirmed relapses in the past year despite interferon-beta-1a therapy. MRI shows five new T2 lesions. Which is the most appropriate next step per ECTRIMS/AAN treat-to-target recommendations?
- A Switch to a different beta-interferon preparation at higher dose
- B Escalate to high-efficacy therapy: natalizumab, alemtuzumab, or ocrelizumab ✓
- C Add azathioprine to current interferon regimen
- D Switch to glatiramer acetate and reassess in 12 months
Explanation
This patient has breakthrough disease on interferon-beta (platform therapy), defined by ongoing relapses and new MRI activity — a high disease activity profile. Current ECTRIMS guidelines and treat-to-target strategies recommend escalation to high-efficacy disease-modifying therapy (HET) such as natalizumab, ocrelizumab, or alemtuzumab. Switching between platform therapies (interferons, glatiramer acetate) is inadequate in the setting of confirmed breakthrough activity. The TREATMS observational data and CARE-MS trials support early use of HET to prevent disability accumulation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.