Lemtrada

Diagnosis of RRMS is in accordance with the McDonald 2017 criteria demonstrating dissemination of lesions in the central nervous system in space and time meeting the following:
i) 2 or more attacks¹ and clinical evidence of 2 or more lesions²;
OR
ii) 2 or more attacks and clinical evidence of 1 lesion with clear historical evidence of prior attack involving lesion in different location;

¹If the patient has experienced only one attack, the patient must meet ONE of the additional criteria of dissemination in time in the list below:
a) Additional clinical attack
b) Simultaneous presence of both enhancing and non-enhancing, symptomatic or asymptomatic MS-typical MRI lesions; OR new T2 or enhancing MRI lesion compared to baseline scan (without regard to timing of baseline scan)
c) Presence of cerebrospinal fluid (CSF)-specific oligoclonal bands

²If the patient has evidence of only one lesion the patient must meet ONE of the additional criteria of dissemination in space in the list below:
a) Additional clinical attack implicating different CNS site
b) 1 or more MS-typical T2 lesions in 2 or more areas of the Central Nervous System (CNS): periventricular, cortical, juxtacortical, infratentorial or spinal cord

AND 

The patient has either:
i) Failed to respond to full and adequate courses of at least TWO of the following therapies*: interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide, or ocrelizumab;
OR
ii) has a documented intolerance or contraindication to two or more of the therapies listed above.

AND 

Patient has experienced a clinical relapse and/or new MS lesions in the last 2 years; AND 

Patient has had a significant increase in T2 lesion load compared with that from a previous MRI scan (i.e., 3 or more new lesions) OR at least one gadolinium-enhancing lesion;

AND