Future prospects: focus on personalized therapy

Approximately 15,000 people in Switzerland are diagnosed with multiple sclerosis. The disease is not yet curable. Still. This is because ever better knowledge of the pathophysiology of the disease is enabling increasingly patient-specific treatment. The focus is on pharmacotherapy, which can increasingly target inflammatory processes in the body to keep them in check and reduce further disease flare-ups.

Chronic inflammation of the central nervous system manifests itself, among other things, in the autoimmune disease multiple sclerosis (MS). Visual, gait and balance disorders, as well as spasticity and paralysis in the further course, are the consequences of the disease, which progresses in episodes. However, how MS develops varies from patient to patient. According to projections, there are approximately 15,000 MS patients living in Switzerland. Among them predominantly (73%) women. In order to better understand the disease, scientists are conducting intensive research into new diagnostic methods and drugs. Thanks to innovative research approaches, drugs based on monoclonal antibodies are now available. However, effective active ingredients that have already been tried and tested are also being continuously developed. The aim is to adapt the treatment management to the relapse activity and the personal clinical picture and thus to tailor the therapy to the individual.

While a few years ago the diagnosis of MS inevitably led to a wheelchair, this is fortunately no longer necessarily the case today. According to experts, half of the patients are still able to walk after 15 years and are not dependent on a wheelchair at all, or only temporarily. A major breakthrough in therapy was achieved with the development of beta-interferons. These are able to delay the course of the disease by suppressing inflammatory processes. This was followed by immunomodulating preparations that can influence the immune system so that it no longer opposes its own body. Meanwhile, treatment management is increasingly focused on modulating the course of the disease and slowing the progression of disability.

Therapy approaches to the point

Various therapeutic approaches are available for the treatment of MS, which can be used individually or in combination at different times depending on the disease situation. One focus is on reducing relapses and slowing disease progression. However, the treatment of accompanying symptoms, such as fatigue, spasticity or sexual dysfunction, must not be ignored. It is precisely this that plays a major role with regard to the quality of life and also for the ability of those affected to work.

In acute therapy during a relapse, high-dose, cortisone-containing prednisolone is administered, especially in the first five years. This serves to reduce the inflammatory process as quickly as possible in order to shorten the relapse. In the long run, however, this approach is not likely to stop or delay the disease. This is where disease-modifying therapies come into play. Immunomodulators and immunosuppressants are administered continuously, and intervene directly in disease processes. While immunomodulators alter inflammatory processes, immunosuppressants suppress the immune system in excess.

Whereas in the past, treatment was started with the basic form of therapy and escalated as needed, there is now an increasing tendency to treat on the basis of the progressive form. For mild or moderate forms, interferons, glatiramer acetate, teriflunomide, or dimethyl fumarate are used. As an alternative to injections, capsules or tablets are now also available. A severe form of the disease, on the other hand, is immediately treated with monoclonal antibodies. These highly specific, biotechnologically produced active ingredients can act in a very targeted manner at various sites and have a lasting positive influence on the disease process.