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Multiple sclerosis: time for early treatment with high-efficacy drugs
K. Selmaj, BAC. Cree, M. Barnett, A. Thompson, HP. Hartung
Jazyk angličtina Země Německo
Typ dokumentu časopisecké články, přehledy
Odkazy
PubMed
37851189
DOI
10.1007/s00415-023-11969-8
Knihovny.cz E-zdroje
- MeSH
- léčivé přípravky MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- relabující-remitující roztroušená skleróza * farmakoterapie MeSH
- roztroušená skleróza * diagnostické zobrazování farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
This review addresses current changes in the approach to treating patients with multiple sclerosis (MS). The widely practiced approach of utilizing agents with lower treatment efficacy (LETA) at onset with subsequent escalation has been challenged by new data suggesting that MS patients derive greater benefit when therapy is initiated with high-efficacy treatment agents (HETA). Several recent studies compared treatment efficacy and safety of early administration of HETA versus LETA. The results of randomized, double blind, phase III studies with LETA as a control arm and population-based larger and longer studies using propensity scoring, marginal structural modeling and weighted cumulative exposure analysis support the benefit of early treatment with HETA. Patients initiating their treatment with HETA, regardless of prognostic factors and MRI burden at baseline, showed significantly lower annualized relapse rate (ARR) and reduced disability progression in follow-up periods of up to 10-15 years. Moreover, the safety profile of recently approved HETA ameliorates concerns about off-target effects associated with a number of earlier high-efficacy drugs. Patient perception has also changed with an increasing preference for medication profiles that both improve symptoms and prevent disease progression. Accumulating data from randomized studies and the results of large population-based studies demonstrating short-term and longer-term patient benefits support the view that HETA should be more widely used. The adoption of early treatment with HETA capitalizes on a window of opportunity for anti-inflammatory drugs to maximally impact disease pathology and heralds a sea change in clinical practice toward pro-active management and away from a philosophy routed in generating clinical benefit as a consequence of treatment failure.
Brain and Mind Centre University of Sydney Sydney Australia
Center of Neurology Lodz Poland
Department of Neurology Heinrich Heine University Düsseldorf Germany
Department of Neurology Medical University of Vienna Vienna Austria
Department of Neurology Palacky University Olomouc Olomouc Czech Republic
Department of Neurology University of Warmia and Mazury 30 Warszawska Ave 10 082 Olsztyn Poland
Department of Neurology Weill Neurosciences Institute UCSF San Francisco USA
Faculty of Brain Sciences University College London London UK
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