Jessica Shipley, James Beharry, Wei Yeh, Nabil Seery, Yi Chao Foong, Darshini Ayton, Pakeeran Siriratnam, Tracie Tan, Heidi Beadnall, Joshua Barton, Francesca Bridge, Robb Wesselingh, Lisa Taylor, Louise Rath, Jodi Haartsen, Mohammad Gadi, Cassie Nesbitt, Michael Zhong, Victoria Cushing, Fiona McKay, Julia Morahan, Benjamin Peter Trewin, Izanne Roos, Mark Marriott, Ai‐Lan Nguyen, Emma Downey, Joanne Crosby, Julian Bosco, Jennifer Taylor, Lauren Giles, Nevin John, Ernest Butler, Anneke van der Walt, Helmut Butzkueven, Stefan Blum, Marion Simpson, Mark Slee, Sudarshini Ramanathan, Todd Hardy, Richard A L Macdonell, Katherine Buzzard, Deborah F Mason, Jeannette Lechner‐Scott, Trevor J Kilpatrick, Tomas Kalincik, Bruce V Taylor, Simon A Broadley, Stephen Reddel, Douglas Johnson, Mastura Monif, Australian and New Zealand Association of Neurologists the MS Interest Group

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system. There were 33 335 people with MS in Australia in 2021 and 2917 in New Zealand in 2006 and the prevalence and incidence are increasing with time. Although new treatments have substantially improved outcomes in recent decades, the treatment landscape has become increasingly complex due to the expanding number of disease-modifying therapies (DMTs) and associated safety considerations. A total of 80 consensus recommendations were developed on the current best-practice management of MS in Australia and New Zealand. Part 1 of these guidelines outlines the consensus recommendations covering domains including DMT counselling and selection, pre-DMT assessments, monitoring disease activity on DMT, switching DMT, and discontinuing DMT. The remaining recommendations are outlined in Part 2, encompassing risk mitigation strategies during treatment with DMT, managing DMT in special situations (including pregnancy, postpartum, breastfeeding, active infection including COVID-19, and malignancy), general lifestyle measures, acute MS relapses, and symptomatic treatments for MS. This two-part position statement provides a practical resource for clinicians on current best-practice consensus recommendations for managing adults (≥ 18 years old) with MS in the Australian and New Zealand health care settings. It outlines the 14 DMTs currently available through the Australian Pharmaceutical Benefits Scheme and eight through the New Zealand Pharmaceutical Schedule, including the unique efficacy, safety and monitoring considerations of each. Through these guidelines, we aim to support safe, timely and effective management of patients with MS in Australia and New Zealand.