Optimizing the initial choice and timing of therapy in relapsing-remitting XXXX .

@entity1 @entity15 @entity194
With 12 available US Food and Drug Administration approved medications for the treatment of relapsing @entity15 ( @entity15 ), choosing an initial therapy is no longer a straightforward task. Each disease-modifying therapy (DMT) has a distinct risk-benefit profile and each @entity1 is an individual. Therefore, the development of a simple algorithm to apply in selecting initial therapy is not feasible. Instead, the prescribing physician must consider many factors related to the treatments themselves, such as efficacy, safety, and tolerability, while also taking into account a particular @entity1 's disease characteristics, personal preferences, comorbid illnesses and reproductive plans. The efficacy of each drug may be assessed through clinical trial data, although these data are limited by scarcity of direct comparisons among the different agents and lack of availability of biomarkers to predict an individual @entity1 's response. Differences in safety profiles help to distinguish the various DMTs and influence selection of agent; both the known safety concerns, which can be addressed with risk mitigation and monitoring strategies, and the potential for yet undiscovered safety issues must be assessed, and an individual @entity1 's comfort level with the risks and ability to comply with monitoring must be determined. Potential issues related to tolerability, which largely relate to matters of @entity1 personal preference and lifestyle, should also be factored into the decision-making process. With regard to the timing of therapy initiation, it must be acknowledged that long-term benefits of early DMT have not yet been definitively demonstrated. Nonetheless, starting DMT early in the @entity15 has been shown to have a beneficial effect on relapse prevention, and appears to curtail the @entity194 and neurodegenerative changes that are now known to begin at disease onset. Although under certain circumstances there are acceptable reasons for deferring treatment, it is generally recommended that DMT is initiated early in the disease course.
