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UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS
VANJA BAŠIĆ KES
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, University of Zagreb, School of Dental Medicine, Zagreb, Croatia
MILJENKA JELENA JURAŠIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, Croatia
IRIS ZAVOREO
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, Croatia
MARIJANA LISAK
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, University of Zagreb, School of Dental Medicine, Zagreb, Croatia
SILVA SOLDO BUTKOVIĆ
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Osijek University Hospital Centre, Department of Neurology, Osijek, Croatia
MARINA TITLIĆ
; Split University Hospital Centre, Department of Neurology, Split, Croatia
MERI MATIJACA
; Split University Hospital Centre, Department of Neurology, Split, Croatia
INES LAZIBAT
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Dubrava University Hospital, Department of Neurology, Zagreb, Croatia
DAVOR JANČULJAK
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Osijek University Hospital Centre, Department of Neurology, Osijek, Croatia
MARIO HABEK
; Zagreb University Hospital Centre, Department of Neurology, Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
MARIJA BOŠNJAK PAŠIĆ
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Zagreb University Hospital Centre, Department of Neurology, Zagreb, Croatia
IVANA ZADRO
; Zagreb University Hospital Centre, Department of Neurology, Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
INGRID ŠKARPA PRPIĆ
; Rijeka University Hospital Centre, Department of Neurology, Rijeka, Croatia
IVANA HUSTIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, Croatia
NEVENA GRBIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, Croatia
IVANA KOBASIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Zagreb, Croatia
TEA MIROŠEVIĆ ZUBONJA
; Osijek University Hospital Centre, Department of Neurology, Osijek, Croatia
ANITA MARČINKO
; Sveti Duh University Hospital, Department of Neurology, Zagreb, Croatia
ANTON VLADIĆ
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Sveti Duh University Hospital, Department of Neurology, Zagreb, Croatia
DOLORES JANKO LABINEC
; Pula General Hospital, Department of Neurology, Pula, Croatia
TIHANA GRŽINČIĆ
; Bjelovar General Hospital, Department of Neurology, Bjelovar, Croatia
BISERKA KOVAČ
; Vukovar General Hospital, Department of Neurology, Vukovar, Croatia
ANKA ALEKSIĆ SHIHABI
; Šibenik General Hospital, Department of Neurology, Šibenik, Croatia
VIDA DEMARIN
; Croatian Academy of Sciences and Arts, Zagreb, Croatia
Abstract
Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines.
Keywords
multiple sclerosis; disease-modifying treatment; guidelines
Hrčak ID:
208635
URI
Publication date:
16.11.2018.
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