Development of an updated national protocol for the use of disease-modifying treatments in multiple sclerosis: a MOH-MOE Steering Committee initiative in Malaysia

Background: There has been an increase in the number of disease-modifying treatments (DMTs) for Multiple Sclerosis (MS). However, treatment accessibility, selection, monitoring, and patientspecific considerations pose constraints in resource-limited settings, such as Malaysia. Objective: This protocol aims to develop a consensus statement that will guide MS management in Malaysia, addressing issues related to treatment and monitoring. Methods: A working group consisting of clinicians, subject matter experts from the Ministry of Health and the Ministry of Education, private medical centers, senior pharmacy officials, and representatives from patient groups has been established at Kuala Lumpur Hospital. The Delphi method, involving iterative rounds of expert voting on key topics, was applied. A systematic literature review focused on high-quality evidence from clinical trials, systematic reviews, and real-world data. Results: The consensus protocol provided comprehensive, evidence-based recommendations for MS management in Malaysia. Key topics addressed include the timing of DMT initiation, selection of treatments for different MS subtypes, strategies for switching treatments due to lack of response, and monitoring protocols. The impact of DMTs on cognition, pregnancy, and breastfeeding was also included. Extra attention was given to overcoming diagnostic and treatment barriers in a middle-income setting, improving access to newer DMTs, and adapting global guidelines to local needs. Conclusion: The consensus statement is expected to serve as a crucial guide for healthcare professionals in managing MS, enhancing early diagn

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