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Neurol Neuroimmunol Neuroinflamm. 2019 Nov 22;7(1). pii: e636. doi: 10.1212/NXI.0000000000000636. Print 2020 Jan.

An argument for broad use of high efficacy treatments in early multiple sclerosis.

Author information

1
From the Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School, Boston, MA. jstankiewicz@bwh.harvard.edu.
2
From the Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School, Boston, MA.

Abstract

Two different treatment paradigms are most often used in multiple sclerosis (MS). An escalation or induction approach is considered when treating a patient early in the disease course. An escalator prioritizes safety, whereas an inducer would favor efficacy. Our understanding of MS pathophysiology has evolved with novel in vivo and in vitro observations. The treatment landscape has also shifted significantly with the approval of over 10 new medications over the past decade alone. Here, we re-examine the treatment approach in light of these recent developments. We believe that recent work suggests that early prediction of the disease course is fraught, the amount of damage to the brain that MS causes is underappreciated, and its impact on patient function oftentimes is underestimated. These concerns, coupled with the recent availability of agents that allow a better therapeutic effect without compromising safety, lead us to believe that initiating higher efficacy treatments early is the best way to achieve the best possible long-term outcomes for people with MS.

PMID:
31757815
DOI:
10.1212/NXI.0000000000000636
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