The need for a strategic therapeutic approach: multiple sclerosis in check

Abstract

Multiple sclerosis (MS) is the most common chronic autoimmune neurological disease. Its therapeutic management has drastically evolved in the recent years with the development of specific disease-modifying therapies (DMTs). Together with the established injectables, oral and intravenous alternatives are now available for MS patients with significant benefits to modulate the disease course. Certain drugs present with a higher efficacy than the others, profiles and frequencies of adverse events differentiate as well. Thus due to the several and different treatment alternatives, the therapeutic approach adopted by neurologists requires a tactical focus for a targeted, timed, and meaningful treatment decision. An integration of rational and emotional control with proper communication skills is necessary for shared decision-making with patients. In this perspective paper, we reinforce the necessary concept of strategic MS treatment approach using all available therapies based on scientific evidence and current experience. We apply a didactic analogy to the strategic game chess. The opening with oriented attack (i.e. already in early disease stages as clinical isolated syndrome), a correct choice of chess pieces to move (i.e. among the several DMTs), a re-assessment reaction to different scenarios (e.g. sustained disease activity, adverse events, and family planning) and the advantage of real-world data are discussed to try the best approach to ultimately successfully approach the best personalized MS treatment.

OzEAN Study to Collect Real-World Evidence of Persistent Use, Effectiveness, and Safety of Ozanimod Over 5 Years in Patients With Relapsing-Remitting Multiple Sclerosis in Germany

“…Second, this will allow for characterization of patients prescribed ozanimod in real-world clinical practice. A question of interest is whether ozanimod is prescribed to patients newly diagnosed with MS, consistent with a shift toward earlier use of high-efficacy disease-modifying therapies ( 29 ), or reserved for patients previously treated with lower-efficacy agents (i.e., an escalation approach) ( 30 ).…”

“…Persistence from baseline to months 12, 24, 36, and 48 is a secondary endpoint. Adherence to therapy, defined as the percentage of ozanimod doses taken as prescribed (as reported by patients) (22), at months 3,6,9,12,15,18,21,24,30,36,42,48,54, and 60, and at the safety follow-up, is a secondary endpoint.…”

“…MS, multiple sclerosis; QoL, quality of life; RRMS, relapsing-remitting multiple sclerosis; SD, standard deviation. therapies (29), or reserved for patients previously treated with lower-efficacy agents (i.e., an escalation approach) (30).…”

MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression

“…The early identification of progression is vital to optimize long-term brain health, and the ability to consistently identify progression, with a high degree of sensitivity and specificity, is directly relevant to this aim. MS management with disease-modifying therapies (DMTs) can delay the accumulation of disability [ 11 , 27 , 28 ]; however, treatment should be adapted according to the phase of the disease and, in many regions, labels of DMTs restrict use to specific phenotypic descriptors (e.g., RRMS; active SPMS) [ 26 ]. Thus, the phenotypic classification of MS, partly based on progression, has implications for treatment decisions.…”

Timely intervention, monitoring and education MATTERS in MS (TIME MATTERS in MS): Development of a globally applicable quality improvement tool

“…Delayed diagnosis and treatment, as well as suboptimal treatment, can result in irreversible accumulation of disability, transition from relapsing-remitting to secondary progressive MS and reduced life quality. [1][2][3] This understanding of MS underpins the MS Brain Health initiative, which aims to preserve neurological reservethe 'brain health'of people living with MS. The initiative's first output was the report Brain health: time matters in multiple sclerosis.…”