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. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Am J Med. 2020 Jul 17;133(12):1380–1390.e2. doi: 10.1016/j.amjmed.2020.05.049

Figure 3. A Therapeutic Algorithm for Disease-Modifying Therapy Use in MS.

Figure 3.

A simplified MS treatment algorithm based on the authors’ practice pattern. Several drugs with proven effectiveness for MS are not mentioned, including: diroximel fumarate (presumably comparable to dimethyl fumerate); cladribine (reserved for MS refractory to at least two other treatments); alemtuzumab and mitoxantrone (not generally recommended due to severe toxicities); hematopoietic stem cell transplantation (reserved for severe treatment refractory disease unresponsive to high efficacy treatments); ozanimod (approved but not yet commercially available).

Abbreviations: DMT, disease-modifying therapy; JCV, John Cunningham virus; MRI, magnetic resonance imaging; MS, multiple sclerosis.