Not all patients have active MS, i.e. relapses within the last 2 years and/or new or enhancing lesions on MRI in the preceding 12 months, and therefore would not be eligible for DMTs under NHS England Guidelines. The same applies for people who have progressive or more advanced MS; we see these patients in the hope of being able to offer them a treatment in the future. Rather than discharge these patients they need to be followed and monitored. This is called watchful waiting.
The following systematic review in the Cochrane library defines and reviews this treatment approach, albeit for other diseases.
The conclusions of this review are telling:
Rittenmeyer et al. The experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment: a qualitative systematic review. JBI Database System Rev Implement Rep. 2016 Feb;14(2):174-255. doi: 10.11124/jbisrir-2016-2270.
BACKGROUND: “Watchful waiting” or “active surveillance” is an alternative approach in the medical management of certain diseases. Most often considered appropriate as an approach to treatment for low-risk prostate cancer, it is also found in the literature in breast cancer surveillance, urinary lithiasis, lymphocytic leukemia, depression and small renal tumors.
OBJECTIVES: This systematic review sought to: Identify and synthesize the best available international evidence on the experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment. To this end the questions addressed in this review were:
RESULTS: A total of 16 studies, critically appraised by two independent reviewers and deemed to be of high quality, were included in the final review. One study was excluded after appraisal. One hundred and fifty-five findings from the 16 studies were extracted into 10 categories and then into three synthesized findings. The synthesized findings explicated: