Factors influencing daily treatment choices in multiple sclerosis:practice guidelines biomarkers and burden of disease

摘要

At two meetings of a Central European board of multiple sclerosis (MS) experts in2018 and 2019 factors influencing daily treatment choices in MS, especiallypractice guidelines, biomarkers and burden of disease, were discussed. Theheterogeneity of MS and the complexity of the available treatment options callfor informed treatment choices. However, evidence from clinical trials isgenerally lacking, particularly regarding sequencing, switches and escalation ofdrugs. Also, there is a need to identify patients who require highly efficacioustreatment from the onset of their disease to prevent deterioration. The recentlypublished European Committee for the Treatment and Research in MultipleSclerosis/European Academy of Neurology clinical practice guidelines onpharmacological management of MS cover aspects such as treatment efficacy,response criteria, strategies to address suboptimal response and safety concernsand are based on expert consensus statements. However, the recommendationsconstitute an excellent framework that should be adapted to local regulations,MS center capacities and infrastructure. Further, available and emergingbiomarkers for treatment guidance were discussed. Magnetic resonance imagingparameters are deemed most reliable at present, even though complex assessmentincluding clinical evaluation and laboratory parameters besides imaging isnecessary in clinical routine. Neurofilament-light chain levels appear torepresent the current most promising non-imaging biomarker. Other immunologicaldata, including issues of immunosenescence, will play an increasingly importantrole for future treatment algorithms. Cognitive impairment has been recognizedas a major contribution to MS disease burden. Regular evaluation of cognitivefunction is recommended in MS patients, although no specific disease-modifyingtreatment has been defined to date. Finally, systematic documentation ofreal-life data is recognized as a great opportunity to tackle unresolved dailyroutine challenges, such as use of sequential therapies, but requires jointefforts across clinics, governments and pharmaceutical companies.