Treatment strategies for multiple sclerosis: When to start, when to change, when to stop?

Table 2 Critical factors affecting the decision of starting disease-modifying therapies for multiple sclerosis

Factors suggesting not to start a DMT	CIS with favourable prognostic factors
	RR MS with no relapses in previous two years, no disability, and no evidence of MRI activity (potential “benign” case)
	Progressive forms of MS with no relapses or evidence of MRI activity
	Pregnancy planning
	High risk of low adherence to treatment
Factors suggesting to start a first line DMT	CIS with unfavourable prognostic factors
	RR MS with at least one relapse in previous two years but less than two relapses in the last year, low residual disability, and/or active MRI
Factors suggesting to start a second line DMT	RR MS with at least 2 disabling relapses in the last year
	Progressive forms of MS with relapses and/or active MRI

DMT: Disease-modifying therapy; CIS: Clinically isolated syndrome; MS: Multiple sclerosis.