Disease modifying therapy switching in relapsing multiple sclerosis: A Delphi consensus of the demyelinating expert group of the Spanish society of neurology

•The increase in DMTs for MS complicates the decisions on initial and subsequent therapies for each patient.•This article collates 99 clinically relevant statements agreed by 25 experts on treatment switching approaches in RMS.•The statements cover treatment objectives, reasons for DMT switching, suboptimal response criteria, strategies for treatment change and washout periods.•The agreed statements provide up-to-date guidance on DMT sequencing for optimal patient management. The increase in available disease modifying therapies (DMTs) for multiple sclerosis has led to greater emphasis on improving treatment sequencing paradigms. This article summarises the opinions from a panel of 25 experts on treatment switching approaches in relapsing multiple sclerosis (RMS). A modified Delphi consensus process was carried out to develop clinically relevant statements for aiding treatment decisions in patients with RMS between the 16th January and the 9th October 2019. A sub-group of two experts (core group) carried out an extensive review of the literature and formulated 106 statements for the expert panel to evaluate. From a total number of 106 statements that were submitted to the expert panel for critical evaluation, consensus (at least 80% of the panelists agreed) was reached on 99 of them. These statements cover treatment objectives, reasons for DMT switching, suboptimal response criteria, strategies for treatment change and washout periods. The agreed statements provide up-to-date guidance on DMT sequencing for optimal patient management.