Disease-modifying therapy for multiple sclerosis

Abstract

Remarkable expansion of new diagnostic criteria and disease-modifying treatments for multiple sclerosis has occurred in the last two decades. Revision of diagnostic criteria and characterization of disease course has allowed earlier diagnosis and better characterization of individual patients. With the current treatment armamentarium in the USA offering 11 agents, patients can now benefit from increasingly individualized therapy. The therapeutic decision-making process has become more complex, with the availability of multiple medications. Relative efficacy, potentially severe adverse events, tolerability issues and patient's preferences must now all be considered so that increasingly disease management more frequently involves physicians with multiple sclerosis subspecialty expertise. This article aims to provide a clinically oriented and concise review of currently available, as well as emerging, disease-modifying treatment therapies in multiple sclerosis.

Advancing Care and Outcomes for African American Patients With Multiple Sclerosis

“…Although the number of patients studied was small, the results suggest a poorer response to at least some DMTs in AAwMS. 27 These findings of increased disability over a shorter disease duration in African Americans are in line with the trend suggested by a post hoc analysis of the EVIDENCE study comparing the response to interferon β-1a treatment in African American (n = 36) and White American (n = 616) patients. In EVIDENCE, African American patients had more new T2-weighted MS lesions on MRI (2.00 vs 1.10; p = 0.04) and were less likely to remain relapse free (47% vs 57%; p = 0.24) at 48 weeks.…”

“…25 Black/AAwMS may be less responsive to certain diseasemodifying therapies (DMTs) than their White counterparts, which may adversely affect their clinical outcomes. 26,27 A retrospective chart review of 67 self-defined African Americans and 67 White Americans living with MS receiving DMTs (interferons, glatiramer acetate, and natalizumab) reported a greater median EDSS difference from baseline through follow-up for African Americans vs White patients (1.0 vs 0; p < 0.001) despite a shorter mean disease duration (7.1 vs 15.1 years; p < 0.001) and similar age at diagnosis (34.3 vs 36.9; p = 0.13). Although the number of patients studied was small, the results suggest a poorer response to at least some DMTs in AAwMS.…”

Eine Übersicht über neuro-ophthalmologische Erkrankungen bei Afroamerikanern und Hispanics mit multipler Sklerose

“…Eine Post-hoc-Analyse der EVIDENCE-Studie, in der die Wirksamkeit von Interferon-β-1a bei therapienaiven MS-Patienten untersucht wurde, zeigte, dass AAwMS, die mit Interferon-β-1a behandelt wurden, eine höhere Anzahl von Exazerbationen aufwiesen, eine höhere Wahrscheinlichkeit für einen Rückfall hatten und nach 48 Wochen eine höhere Anzahl neuer T2-Läsionen entwickelten als CAwMS [72]. Dieses unterschiedliche Ansprechen auf die Behandlung wurde in einer retrospektiven Übersichtsarbeit weiter veranschaulicht, in der das Ansprechen auf Interferon-β-1a oder Interferon-β-1b, Glatirameracetat sowie Natalizumab bei AAwMS im Vergleich zu CAwMS verglichen wurde, was darauf hindeutet, dass diese Beziehung unter den frühen DMT nicht DMT-spezifisch ist [73]. Derzeit gibt es nur sehr wenige Daten zur Bewertung der DMT-Exposition bei HwMS, sodass analoge Vergleiche nicht möglich sind.…”

Strengthened through Diversity: A Blueprint for Organizational Change

“…The underrepresentation of women and minorities in clinical trials not only obfuscates the efficacy of neurological treatments and therapies in underrepresented groups, resulting in a selection bias of treatments that are most effective in Whites, but may not have equal efficacy in minority populations. For example, recruitment of people of color into contemporary disease‐modifying MS drug trials was so low that one cannot determine their efficacy and safety in these patient groups 71 ; this may contribute to differential responses to disease‐modifying therapies in MS care in minority populations 71–74 …”

“…For example, recruitment of people of color into contemporary disease-modifying MS drug trials was so low that one cannot determine their efficacy and safety in these patient groups 71 ; this may contribute to differential responses to disease-modifying therapies in MS care in minority populations. [71][72][73][74] Action Steps: We will utilize ANA committee structures to advocate that neurology clinical trials and epidemiological studies should be designed in such a manner as to encourage and facilitate the enrollment of women and racial/ethnic minorities. Previous attempts to increase enrollment, including community outreach or the use of community advisory boards to increase interest, are likely insufficient based on the continued low enrollment.…”