Current and future directions in MS management: key considerations for managed care pharmacists.

BACKGROUND: The management paradigm for multiple sclerosis (MS) continues to evolve and is shifting toward earlier diagnosis, differentiation of patients with varying clinical prognoses, and earlier initiation of treatment in selected individuals. Based on surveys conducted at the 2008 annual conference of the Academy of Managed Care Pharmacy (AMCP) and at regional meetings held in 2009, several topics were identified for which pharmacists indicated a need for new and updated information. OBJECTIVE: To review (a) recent insights into the pathophysiology underlying MS, (b) the improvements in identification of patients with a clinically isolated syndrome (CIS) who will progress to clinically definite MS (CDMS), (c) the current role of magnetic resonance imaging (MRI) and other technologies in the diagnosis and ongoing management of MS, (d) the optimal time to initiate treatment in patients with CIS or MS, and (e) the potential utility of new and emerging therapies in MS management. METHODS: The medical edu...