Neuros advised not to prescribe ABCRs for progressive MS

 
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PostPosted: Sat Feb 23, 2013 6:37 pm    Post subject: Neuros advised not to prescribe ABCRs for progressive MS Reply with quote

The American Academy of Neurology (AAN) has come up with 5 recommendations for neuros. Recommendation #4 is not to prescribe the ABCR drugs for progressive forms of MS (PPMS, SPMS, etc.).



Quote:
Neurology. 2013 Feb 20.

The American Academy of Neurology's Top Five Choosing Wisely recommendations

Langer-Gould AM, Anderson WE, Armstrong MJ, Cohen AB, Eccher MA, Iverson DJ, Potrebic SB, Becker A, Larson R, Gedan A, Getchius TS, Gronseth GS.

From the Neurology Department, Los Angeles Medical Center (A.M.L.-G.), Southern California Kaiser Permanente Medical Group (S.B.P.), Los Angeles; Department of Research & Evaluation (A.M.L.-G.), Kaiser Permanente Southern California, Pasadena; California Pacific Neurosciences Institute (W.E.A.), San Francisco; Department of Neurology (M.J.A.), University of Maryland School of Medicine, Baltimore; Massachusetts General Hospital (A.B.C.), Harvard Medical School, Cambridge; Geisinger Medical Center (M.A.E.), Danville, PA; Humboldt Neurological Medical Group, Inc. (D.J.I.), Eureka, CA; American Academy of Neurology (A.B., R.L., A.G., T.G.), Minneapolis, MN; and University of Kansas Medical Center (G.S.G.), Kansas City.

OBJECTIVE:

To discuss the American Academy of Neurology (AAN)'s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports.

METHODS:

A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations.

RESULTS AND RECOMMENDATIONS:

The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012.

Recommendation 1: Don't perform EEGs for headaches.

Recommendation 2: Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.

Recommendation 3: Don't use opioids or butalbital for treatment of migraine, except as a last resort.

Recommendation 4: Don't prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis.

Recommendation 5: Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).

PMID:23430685


The abstract can be seen here.

More information on these recommendations is here.
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agate
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Posts: 5694
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PostPosted: Fri Apr 19, 2013 6:08 pm    Post subject: Concern about the MS recommendation expressed Reply with quote

There seems to have been some opposition to this recommendation. This is an abstract from an expression of concern on the part of the editors of the journal Neurology.

From PubMed, April 19, 2013:

Quote:
Neurology. 2013 Apr 17.

EXPRESSION OF CONCERN: The American Academy of Neurology's Top Five Choosing Wisely recommendations

[No authors listed]

The editors express concern about a recommendation in the report "The American Academy of Neurology's Top Five Choosing Wisely recommendations" (Neurology® 2013 Feb 20...). The Methods section contained wording indicating that the AAN Working Group sent the final 7 candidate recommendations to relevant AAN Sections and Committees, specialty societies, and patient advocacy organizations for review before voting on the final recommendations. In fact, as the result of an oversight by AAN staff, the Multiple Sclerosis Section of the AAN was not asked for their input, which was relevant for the fourth recommendation, "Don't prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis."

Several members of the Multiple Sclerosis Section have responded in Neurology's WriteClick online correspondence with major concerns about this recommendation.

Further evaluation is under way to determine whether the authors will change the recommendation after review by the Section.

PMID:23596081


The abstract can be seen here.
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