A 55-year-old woman with relapsing-remitting MS develops acute unilateral optic neuritis. She has had two relapses in the past year. MRI shows 12 T2 lesions. She is currently on interferon beta-1a. What would be the MOST appropriate change to disease-modifying therapy?
- A Switch to high-efficacy therapy such as natalizumab or ocrelizumab ✓
- B Add azathioprine to interferon beta-1a
- C Increase interferon beta-1a dose and add monthly IVIG
- D Continue interferon and treat each relapse with IV methylprednisolone
Correct answer: A. Switch to high-efficacy therapy such as natalizumab or ocrelizumab
Explanation
This patient has highly active RRMS (two relapses on platform therapy, 12 MRI lesions). Current MS guidelines (McDonald criteria, EAN recommendations) support escalation to high-efficacy disease-modifying therapies such as natalizumab (anti-VLA-4), ocrelizumab (anti-CD20), or alemtuzumab in patients who fail platform therapies. Continuing interferons with add-on immunosuppressants is not an evidence-based escalation strategy. Treating only relapses without modifying disease course is inadequate given the activity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.