At two meetings of a Central European board of multiple sclerosis (MS) experts in 2018 and 2019 factors influencing daily treatment choices in MS, especially practice guidelines, biomarkers and burden of disease, were discussed. The heterogeneity of MS and the complexity of the available treatment options call for informed treatment choices. However, evidence from clinical trials is generally lacking, particularly regarding sequencing, switches and escalation of drugs. Also, there is a need to identify patients who require highly efficacious treatment from the onset of their disease to prevent deterioration. The recently published European Committee for the Treatment and Research in Multiple Sclerosis/European Academy of Neurology clinical practice guidelines on pharmacological management of MS cover aspects such as treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and are based on expert consensus statements. However, the recommendations constitute an excellent framework that should be adapted to local regulations, MS center capacities and infrastructure. Further, available and emerging biomarkers for treatment guidance were discussed. Magnetic resonance imaging parameters are deemed most reliable at present, even though complex assessment including clinical evaluation and laboratory parameters besides imaging is necessary in clinical routine. Neurofilament-light chain levels appear to represent the current most promising non-imaging biomarker. Other immunological data, including issues of immunosenescence, will play an increasingly important role for future treatment algorithms. Cognitive impairment has been recognized as a major contribution to MS disease burden. Regular evaluation of cognitive function is recommended in MS patients, although no specific disease-modifying treatment has been defined to date. Finally, systematic documentation of real-life data is recognized as a great opportunity to tackle unresolved daily routine challenges, such as use of sequential therapies, but requires joint efforts across clinics, governments and pharmaceutical companies.

Centrum Teplice Teplice Czech Republic

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Neurology and MTA SZTE Neuroscience Research Group University of Szeged Szeged Hungary

Department of Neurology Comenius University Bratislava Slovakia

Department of Neurology Faculty of Medical Sciences in Zabrze Medical University of Silesia in Katowice Poland

Department of Neurology Faculty of Medicine University of Debrecen Debrecen Hungary

Department of Neurology Jahn Ferenc Dél pesti Hospital Budapest Hungary

Department of Neurology Landesklinikum Mistelbach Gänserndorf Mistelbach Austria and Department of Neurology Christian Doppler Medical Center Paracelsus Medical University Salzburg Austria

Department of Neurology Masaryk University Brno Czech Republic

Department of Neurology Medical University of Graz Graz Austria

Department of Neurology Medical University of Lublin Lublin Poland

Department of Neurology Medical University of Vienna Vienna Austria

Department of Neurology Medical University of Vienna Waehringer Guertel 18 20 Vienna 1090 Austria

Department of Neurology P J Šafárik University Košice and University Hospital of L Pasteur Košice Slovakia

Department of Neurology University Clinical Centre Ljubljana Ljubljana Slovenia

Department of Neurology University Medical Centre Maribor Maribor Slovenia

Department of Neurology University of Prešov and Teaching Hospital of J A Reiman Prešov Slovakia

Department of Neurology University of Southern Denmark Odense Denmark

Department of Neurology University of Warmia Mazury Olsztyn Poland

Department of Radiology MRI Unit 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

European Health Economics AB Stockholm Sweden

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Identification of alemtuzumab-suitable multiple sclerosis patients in Slovakia and sequencing of post-alemtuzumab immunomodulatory treatment

Predictors of treatment switching in the Big Multiple Sclerosis Data Network