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It's becoming clear. Bring on the big guns early—don't wait. -D
Paradigm shifts: Early initiation of high-efficacy disease-modifying treatment in multiple sclerosis
Hans-Peter Hartung, Sven G Meuth, Alan J Thompson
First Published September 2, 2021 Editorial
https://doi.org/10.1177/13524585211033190
Clinical development of disease-modifying drugs for the treatment of multiple sclerosis (MS) has been exceedingly successful over the past three decades.1 This in part reflects advances in our knowledge of the pathogenetic underpinnings of the disease and improvement in trial design permitting more rapid translation. The available arsenal contains up to 18 drugs depending on countries location and income,2 that differ in efficacy, route and timing of administration, side effects, risks and tolerability. Starting with the injectable interferons and glatiramer acetate, the introduction of the first monoclonal antibody curtailing lymphocyte invasion of the central nervous system (CNS), the first long-awaited oral agents and the high-efficacy lymphocyte-depleting monoclonal antibodies, many patients with the relapsing forms of MS and fewer with progressive disease clearly receive therapeutic benefit from these disease-modifying agents.
In the absence of a cure for this chronic disorder, timing and sequencing of treatments are of key importance in achieving optimal outcomes for individuals with MS....
FULL EDITORIAL (FREE): https://journals.sagepub.com/doi/ful...24585211033190
Early high-efficacy or early intensive therapy is based on the idea that one should capitalize on a window of opportunity open for drugs to unfold their maximal anti-inflammatory actions when they are most likely to be most beneficial. Patients deemed to have a poorer prognosis with clinical and radiological evidence of high disease activity would receive high-efficacy or intensive therapy. Natalizumab, alemtuzumab, rituximab, ocrelizumab, ofatumumab, cladribine or mitoxantrone are considered to belong to his group. Most experts would include the sphingosine-1-phosphate receptor modulators in this category.
Paradigm shifts: Early initiation of high-efficacy disease-modifying treatment in multiple sclerosis
Hans-Peter Hartung, Sven G Meuth, Alan J Thompson
First Published September 2, 2021 Editorial
https://doi.org/10.1177/13524585211033190
Clinical development of disease-modifying drugs for the treatment of multiple sclerosis (MS) has been exceedingly successful over the past three decades.1 This in part reflects advances in our knowledge of the pathogenetic underpinnings of the disease and improvement in trial design permitting more rapid translation. The available arsenal contains up to 18 drugs depending on countries location and income,2 that differ in efficacy, route and timing of administration, side effects, risks and tolerability. Starting with the injectable interferons and glatiramer acetate, the introduction of the first monoclonal antibody curtailing lymphocyte invasion of the central nervous system (CNS), the first long-awaited oral agents and the high-efficacy lymphocyte-depleting monoclonal antibodies, many patients with the relapsing forms of MS and fewer with progressive disease clearly receive therapeutic benefit from these disease-modifying agents.
In the absence of a cure for this chronic disorder, timing and sequencing of treatments are of key importance in achieving optimal outcomes for individuals with MS....
While it is now undisputable that early initiation of DMT generates greater benefit to patients both in the short- and long-term, deliberations are still ongoing as to whether the escalation approach commencing with medium-efficacy DMTs should be superseded by the high-efficacy/early intensive management approach. Given the large body of convergent evidence that has been accumulated recently through careful interrogation of large databases, there may now be sufficient evidence for the community to consider a new treatment paradigm now rather than waiting until the conclusion of the two ongoing controlled trials.
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