Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Multiple sclerosis

Effective treatment strategies right from the start – opportunities, risks, benefits

    • Education
    • Neurology
    • Rheumatology
    • RX
    • Studies
  • 3 minute read

Treatment of multiple sclerosis is aimed at reducing relapses, lowering disease activity, and slowing the progression of the disease and increase in disability. Both course and long-term therapy with e.g. immunomodulatory or immunosuppressive drugs can be used for this purpose. But what is indicated and when?

Multiple sclerosis (MS) is not just MS – that is well known. In fact, there certainly seems to be a high proportion of patients with benign courses. A study published last year indicated that after a 30-year follow-up, 40% of those with RRMS were still fully ambulatory (EDSS <3.5) [1]. The study is based on follow-up data of individuals with clinically isolated syndrome (CIS). 80 out of 120 patients developed MS within the observation period. In about one third of the cases, the MS was secondary progressive (SPMS) and all of them had EDSS scores above 3.5 at the end. MS led to premature death in one-fifth of all people with the disease. Because no immunomodulatory therapies were available outside of trials at the time of enrollment, only 11 patients received disease-modifying treatment. This suggests that not all MS takes a malignant course and therefore mild treatment regimens or a wait-and-see strategy may be warranted. Furthermore, in a Swedish cohort study, it was observed that under highly active therapies, the risk of infection in MS patients is increased compared to the normal population [2]. This is due in part to an emerging immunoglobulin deficiency associated with infections that can occur with disease-modifying treatments.

Hit hard and early – the right strategy?

In contrast, a registry analysis concludes that early and intensive therapy can slow the progression of MS disease more than an escalation strategy [3]. For this purpose, an early start of highly active therapy or escalation to higher active treatment in the period up to two years after diagnosis was compared with a later start or escalation four to six years after diagnosis. It was found that the prognosis of MS patients with early onset was better by about one EDSS point after six to ten years of therapy. In addition, studies that have evaluated highly active agents against less active agents demonstrate that immunotherapy is associated with a significantly better outcome [4].

Autologous stem cell transplantation (aHSCT) is available as ultima ratio. However, not all patients are suitable for these. In this case, all other options should be exhausted in advance and the patient should be fully informed (Table 1) [5].

 

 

Evidence supports highly effective MS therapy

If the high NEDA rates and improvement in EDSS are taken as a basis, the evidence clearly supports the use of highly effective treatment options from the outset. In the meantime, a better understanding of the possible side effects has also been gained, so that these can be managed well. Nevertheless, the focus should be on comprehensive diagnostics and patients should be selected individually according to the benefit/risk profile.

 

Literature:

  1. Chung KK, et al: A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes. Ann Neurol 2020; 87(1): 63-74.
  2. Luna G, et al: Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies. JAMA Neurol 2019; 77(2): 184-191.
  3. He A, et al: Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol 2020; 19(4): 307-316.
  4. Hauser SL, et al: Ofatumumab versus teriflunomide in multiple sclerosis. N Engl J Med 2020; 383: 546-557.
  5. Gavrillaki, et al: Autologous Hematopoietic Cell Transplantation in Multiple Sclerosis: Changing Paradigms in the Era of Novel Agents. Stem Cells Int 2019; 5840286.

 

InFo NEUROLOGY & PSYCHIATRY 2021; 19(3): 28.

Autoren
  • Leoni Burggraf
Publikation
  • InFo NEUROLOGIE & PSYCHIATRIE
Related Topics
  • Immunomodulation
  • Immunosuppression
  • Multiple sclerosis
Previous Article
  • Uterine tumors

State of the Art

  • CME continuing education
  • Education
  • Gynecology
  • Oncology
  • RX
  • Studies
  • Surgery
View Post
Next Article
  • Psoriasis vulgaris

Patient-adapted biologics therapy – What does the new S3 guideline say?

  • Congress Reports
  • Dermatology and venereology
  • Rheumatology
  • RX
  • Studies
View Post
You May Also Like
View Post
  • 4 min
  • Case report: Drug-induced hepatitis

Rare side effect of tirzepatide therapy

    • Cases
    • Education
    • Endocrinology and Diabetology
    • Gastroenterology and Hepatology
    • Pharmacology and toxicology
    • RX
    • Studies
View Post
  • 4 min
  • Plea for sex-specific neurology

Migraine in men: underdiagnosed, underestimated, under-researched

    • Education
    • Neurology
    • RX
    • Studies
View Post
  • 4 min
  • Prurigo nodularis

Retrospective analyses of large data sets from everyday practice

    • Allergology and clinical immunology
    • Congress Reports
    • Dermatology and venereology
    • RX
View Post
  • 3 min
  • Public Health

Outpatient care in Switzerland: situation report

    • General Internal Medicine
    • Practice Management
    • Prevention and health care
    • RX
View Post
  • 5 min
  • Practice Management

Improved quality of care aims for satisfied patients

    • CME continuing education
    • General Internal Medicine
    • Practice Management
    • Prevention and health care
    • RX
    • Studies
View Post
  • 30 min
  • Chemsex - MSM, sex, chrystal meth & co.

Medical and psychosocial perspectives

    • CME continuing education
    • General Internal Medicine
    • Infectiology
    • Pharmacology and toxicology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • RX
View Post
  • 3 min
  • Bladder cancer

Tuberculosis vaccination reduces recurrences

    • Congress Reports
    • Oncology
    • Pneumology
    • Prevention and health care
    • RX
    • Studies
    • Urology
View Post
  • 4 min
  • Oral JAK-i in atopic dermatitis

Benefits and risks: What does the current data say?

    • Allergology and clinical immunology
    • Congress Reports
    • Dermatology and venereology
    • RX
    • Studies
Top Partner Content
  • Forum Gastroenterology

    Zum Thema
  • Herpes zoster

    Zum Thema
  • Dermatology News

    Zum Thema
Top CME content
  • 1
    Patience, knowledge and persistence in therapy
  • 2
    Sarcopenia and malnutrition in the context of pneumological rehabilitation
  • 3
    Medical and psychosocial perspectives
  • 4
    New nomenclature for non-alcoholic fatty liver disease
  • 5
    Examinations and considerations before therapy

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.