Medicus, Vol. 28 No. 1 Neurologija, 2019.
Pregledni rad
New Approach to the Treatment of Multiple Sclerosis
Mario Habek
Sažetak
Currently, more than 10 different drugs have been approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). Some of them have slight to moderate efficacy combined with a good safety profile, whereas others have high efficacy, but a less favourable safety profile. Numerous therapeutic options available make it difficult to choose optimum treatment for patients with RRMS. In order to properly assess the benefits and risks of treatment with each of the specified drugs, it is necessary to know a drug’s mechanism of action, data on its efficacy in reducing the relapse rate and disability progression, as well as its safety profile. Clinical practice data indicate that only a certain number of patients respond to a drug, thus making the choice of an appropriate drug for each patient very difficult. Furthermore, despite major breakthroughs in the treatment of MS, there is still no biomarker that could enable individualized selection of a drug best suited for a patient. Selection of a drug depends on the disease activity, which is generally defined on the basis of relapse rate, on the disability status measured on the Expanded Disability Status Scale (EDSS) and on the MRI findings (number and volume of T2 lesions, number of T1 contrast-enhanced lesions). However, despite numerous indicators of disease activity, there are still no clear accepted criteria to define RRMS as mildly or highly active. Another challenge is identifying patients during the early stage of MS who are likely to develop a more severe form of the disease. There are two therapeutic approaches to the treatment of MS. The first approach implies continuous treatment (i.e. maintenance therapy) which can be optimised depending on the course of the disease. Such escalation therapy can be carried out in two ways depending on the activity of the disease. Patients with highly active MS begin treatment with high efficacy drugs right from the onset of the disease, even during the clinically isolated syndrome, if the prognostic factors are negative. In contrast, patients with mild MS start treatment with drugs demonstrating moderate efficacy and excellent safety profile. When such drugs are no longer effective, patients are switched to high efficacy drugs with a less favourable safety profile. This approach implies that patients receive continuous treatment. The second approach involves immune reconstitution where pulse immune therapy is used to (temporarily or permanently) reset the immune system, potentially leading to permanent remission. After receiving one of these drugs, the patient can continue without treatment, receive additional cycles of the same drug as required, or continue to receive maintenance treatment with one of the drugs demonstrating moderate efficacy and excellent safety profile.
Ključne riječi
relapsing-remitting multiple sclerosis; optimal treatment; relapse; disability; maintenance therapy; immune reconstitution therapy
Hrčak ID:
216810
URI
Datum izdavanja:
6.2.2019.
Posjeta: 9.963 *