Therapeutic failure in relapsing-remitting multiple sclerosis: Definition and algorithm for management, an expert consensus

Abstract

Introduction: Multiple sclerosis is a chronic neurodegenerative and autoimmune disease of the central nervous system. In Colombia, is the most common rare-orphan disease, with 3,224 reported cases between 2016 and 2021. The treatment is based on a variety of disease-modifying therapies aimed at reducing relapses, decreasing imaging activity, and delaying the progression of disability. However, clinical management presents challenges due to the lack of clear definitions of disease-modifying therapy failure and the absence of explicit guidelines for treatment changes. Objective: Develop a definition of therapeutic failure and design an algorithm for management of therapeutic failure in patients with relapsing multiple sclerosis in Colombia Materials and methods: An expert consensus was carried out using the Delphi methodology in two virtual rounds with 10 experts. A literature review was conducted to gather information for designing the definition and therapeutic failure algorithm. Results: A definition of therapeutic failure was elaborated, including an introduction and the description of clinical variables used to determine if a patient is experiencing therapeutic failure. An algorithm was developed with a therapeutic optimization strategy considering the individual needs of each patient based on the previously designed definition. Conclusions: A definition and a specific management algorithm for Colombia were developed based on evidence, clinical experience, and expert recommendations. These tools will improve decision-making, follow-up, and treatment efficiency and will be updated periodically to reflect scientific advances and best practices.