Can we quantify the benefits of DMDs in multiple sclerosis?

摘要

There are two key questions relating to the clinical use and value of so-called disease-modifying drugs (DMDs) in the treatment of multiple sclerosis (MS). At what stage should they be started? And do they have any effect on long-term disability? To address these questions fully requires a greater understanding of the mechanisms underlying the development of disability together with the results of long-term clinical trials. As far as mechanisms underlying disability are concerned, clarification of the relation between inflammation, demyelination, and axonal loss is crucial. The main substrate of irreversible disability is axonal loss, and imaging studies have shown loss of brain volume (implying axonal loss) early in the course of the disease. Whether this axonal loss is a direct consequence of inflammation is unclear, and there is evidence from pathology and imaging to suggest that focal abnormalities (implicating inflammation) and more diffuse change may be occurring independently.