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Highly effective disease-modifying treatment as initial MS therapy.
Schmierer, Klaus; Sørensen, Per S; Baker, David.
  • Schmierer K; The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.
  • Sørensen PS; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK.
  • Baker D; Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet.
Curr Opin Neurol ; 34(3): 286-294, 2021 06 01.
Статья в английский | MEDLINE | ID: covidwho-1895869
ABSTRACT
PURPOSE OF REVIEW Using highly effective (HE) compounds right from the beginning of disease-modifying immunotherapy (DMT) in people with multiple sclerosis (pwMS) has gained popularity among clinicians and pwMS alike. We discuss the most recent evidence supporting this approach, and whether any of the associated risks should stop us adopting it as a default strategy. RECENT

FINDINGS:

With the addition of injectable ofatumumab, and the two oral sphingosine one phosphate modulators siponimod and ozanimod, ten HE DMTs are now available for pwMS, though variation in licensing status and cost may limit their use in some healthcare environments. Real World evidence based on large MS registry data suggests the superiority of early HE DMT over a slow treatment escalation approach; delaying HE DMT leads to more rapid and often irreversible disability accrual. Mechanistically, B-cell depletion, particularly memory B-cell suppression, is a common denominator closely associated with DMT efficacy.

SUMMARY:

The concept that HE DMTs are necessarily associated with a high risk of adverse effects, is no longer supported by the evidence. The rather predictable and manageable risk profile of most HE DMTs should lower the threshold for clinicians to discuss such treatment with pwMS as a first line approach.
Тема - темы

Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Multiple Sclerosis Тип исследования: Экспериментальные исследования / Прогностическое исследование Пределы темы: Люди Язык: английский Журнал: Curr Opin Neurol Тематика журнала: Неврология Год: 2021 Тип: Статья

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Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Multiple Sclerosis Тип исследования: Экспериментальные исследования / Прогностическое исследование Пределы темы: Люди Язык: английский Журнал: Curr Opin Neurol Тематика журнала: Неврология Год: 2021 Тип: Статья