Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis: perspectives and approaches
Autor: | Francois Grand'Maison, Sarah A. Morrow, Francois Emond, Brian J. Ward, Liesly Lee, Pierre Laneuville, Robyn Schecter, Michael Yeung |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
Review Treatment goals Disease immune effects treatment optimization 03 medical and health sciences 0302 clinical medicine Developmental Neuroscience medicine In patient 030212 general & internal medicine therapeutic inertia Intensive care medicine Secondary progressive business.industry Multiple sclerosis relapsing multiple sclerosis medicine.disease sub-optimal treatment high efficacy disease-modifying therapies Sequence selection treatment sequencing progressive disease business 030217 neurology & neurosurgery Progressive disease Relapsing-remitting course |
Zdroj: | Neural Regeneration Research |
ISSN: | 1673-5374 |
Popis: | Multiple sclerosis (MS) is characterized by chronic inflammation in conjunction with neurodegeneration within the central nervous system. Most individuals with MS begin with a relapsing remitting course that later transitions to secondary progressive MS. Currently available disease-modifying therapies (DMTs) for relapsing MS have been demonstrated to reduce disease activity, however most patients require a change in therapy over the course of their disease. Treatment goals include the prevention of relapses and disability accumulation and to achieve this objective requires careful planning. Sequencing of DMTs for individual patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes. |
Databáze: | OpenAIRE |
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