Effective treatment of multiple sclerosis goes well beyond just MRI findings or blood work. Physical and mental well-being is at least as important for those affected. Therefore, more and more therapies focus on improving the quality of life. Thanks to modern disease-modifying drugs, slowing the progression of disability is no longer wishful thinking.
A good and self-determined life despite multiple sclerosis (MS) – nowadays this no longer has to remain a wish. Thanks to intensive research, treatment management has been advanced in recent decades and is showing results. Meanwhile, it is possible to intervene early in the disease process and significantly delay MS progression. This also has an impact on the quality of life. According to WHO, this is defined as “a person’s subjective perception of his or her position in life in the context of his or her cultural context and the value systems in which he or she lives and in relation to his or her goals, expectations, standards, and concerns” [1]. For people with a chronic illness, physical and mental health play a particularly important role. This is because limiting accompanying symptoms such as fatigue, concentration and memory disorders or spasticity and incontinence can place a heavy burden on everyday life. In addition, there are gait disturbances and balance problems that further reduce the quality of life. Not only does the risk of falling increase – reduced mobility also often means having to call on help. This is a particularly stressful situation for young patients.
A review of 855 patient data from the Swiss Multiple Sclerosis Registry analyzed the impact of different symptoms on health-related quality of life [2]. It included 611 participants with relapsing-remitting MS (RRMS) and 244 with a progressive form (PMS). It was found that in RRMS, gait and balance problems in particular had the greatest impact on quality of life. In PMS, spasticity, paralysis, and bowel problems had the greatest impact. At the patient level, RRMS has been associated with balance disorders, depression, dizziness, and spasticity, and PMS with weakness, pain, and paralysis. Overall, it has been demonstrated that many symptoms with the greatest impact on individuals also contribute significantly to the disease burden of patient clientele.
Early start of treatment to maintain quality of life
Therefore, the goal of modern treatment management of MS is not only freedom from disease activity, but also a focus on quality of life. Therefore, not only effective therapy but also early intervention is indicated. Immunotherapies aim to modify the immune response. In this way, the immune system, which is misdirected in MS, can be influenced. Depending on the course of the disease and the individual circumstances, the therapy can nowadays be specifically adapted. Among other things, a distinction is made between continuous and impulse therapy. In the case of long-term medication, the preparations are administered regularly. This can be done from daily to once every six months to maintain the effect over a long period of time. Impulse therapy involves treatment over a short period of time in order to achieve the longest possible therapeutic effect.
For example, in short-term oral therapy with cladribine, four treatment cycles are scheduled over two years. Two cycles of four to five treatment days are performed per year, one month apart. Recent interim data now demonstrate a significant improvement in quality of life for the agent in relapsing-remitting MS after the first treatment phase [3].
The sphingosine-1-phosphate receptor-1 (S1P1) modulator ponesimod offers another, more recent option. Its mechanism of action is based, among other things, on the reduction of lymphocyte infiltration into the central nervous system. The tablet is taken once a day. Compared with teriflunomide, there was significant superiority over the 108-week period in terms of a 30.5% reduction in annualized recurrence rate (ARR) and a significant reduction in active lesions in the brain [4].
Literature:
- www.who.int/mental_health/media/68.pdf (last access: 08.09.2021)
- Barin L, Salmen A, Disanto G, et al: The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most? Multiple Sclerosis and related Disorders 2018; 25: 112-121.
- Solari A, Montalban X, Lechner-Scott J, et al: Improvements in QoL at 1 Year in Patients Treated With Cladribine Tablets for Highly Active Relapsing MS: An Interim Analysis of CLARIFY-MS. e-Poster P238. 10/13/2021, EXTRIMS 2021.
- Ponvory® (Ponesimod) Specialty Information. November 2021; www.swissmedicinfo.ch
InFo NEUROLOGY & PSYCHIATRY 2022; 20(2): 22.
