Optimizing therapy early in multiple sclerosis: An evidence-based view

Abstract

Therapies that target the underlying pathology of multiple sclerosis (MS), including focal and diffuse damage, may improve long-term disease control. Focal damage (inflammatory lesions) manifests clinically mainly as relapses, whereas diffuse damage (neurodegeneration and brain volume loss) has been more closely associated with disability progression and cognitive decline. Given that first-line therapies such as beta-interferon and glatiramer acetate, which are primarily directed against inflammation, might fail to adequately control disease activity in some patients, it has been recommended to switch these patients early to a therapy of higher efficacy, possibly targeting both components of MS pathology more rigorously. This review provides an overview of the efficacy of EU-approved disease-modifying therapies on conventional MS outcome measures (relapses, disability progression and paraclinical magnetic resonance imaging endpoints) in addition to brain volume loss, a measure of diffuse damage in the brain. In addition, the evidence supporting early treatment optimization in patients with high disease activity despite first-line therapy will be reviewed and an algorithm for optimal disease control will be presented.

The future of multiple sclerosis treatments

“…The effects of MS treatments on disability progression relate with the effects on atrophy over 2 years, independently from the effect on active MRI lesions [185]. This would support the use of brain atrophy as a surrogate marker of disability progression [186]. However, routinely assessing atrophy is difficult due to logistical and technical restraints (for example variability between scans and scanners).…”

Induction treatment strategy in multiple sclerosis: a review of past experiences and future perspectives

“…Since in our treatment landscape we still do not have drugs able to modify the neurodegenerative component of disease, one would want to time treatment to coincide with the presence of ongoing inflammation. This concept has been defined has "treatment window" [9] in which we can detect the early opportunity to influence the accumulation of irreversible long-term damage, choosing high-efficacy therapy that targets both focal and diffuse pathology thus having a favorable impact on long-term outcomes [10]. However induction strategy, and particularly those drugs that are considered to be good candidate to fall in this category, cannot be used in every patients due to safety concerns that are often associated with their use.…”

Multiple Sclerosis

“…Spesifik olarak antijen ile indüklenmiş hızlı prolifere olan lenfositler üzerine etkilidir. Aktive T ve B lenfosit sayısında azalmaya yol açar (35,36). Günde bir kez alınan 7 ya da 14 mg'lık tabletleri mevcuttur.…”

“…Genelde 14 mg lık doz tercih edilmektedir. TEMSO ve TOWERS çalışmalarında, yıllık atak oranında %31-36 oranında azalma gözlenmiştir (36,37).…”

“…Gebelerde kontrendikedir. Erkek hasta kullanıyorsa eşi de korunmalıdır (36). Anti JCV antikoru pozitif hastalar PML gelişim riski açısından Natalizumab kullanan tüm hastalara göre 2 kat artmış riske sahiptir.…”