Informace o publikaci

Factors influencing daily treatment choices in multiple sclerosis: practice guidelines, biomarkers and burden of disease

Autoři	BERGER Thomas ADAMCZYK-SOWA Monika CSEPANY Tunde FAZEKAS Franz FABJAN Tanja Hojs HORAKOVA Dana LEDINEK Alenka Horvat ILLES Zsolt KOBELT Gisela JAZBEC Sasa Sega KLIMOVA Eleonora LEUTMEZER Fritz REJDAK Konrad ROZSA Csilla SELLNER Johann SELMAJ Krzysztof ŠTOURAČ Pavel SZILASIOVA Jarmila TURCANI Peter VACHOVA Marta VANECKOVA Manuela VECSEI Laszlo HAVRDOVA Eva Kubala
Rok publikování	2020
Druh	Článek v odborném periodiku
Časopis / Zdroj	THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
www	https://journals.sagepub.com/doi/pdf/10.1177/1756286420975223
Doi	http://dx.doi.org/10.1177/1756286420975223
Klíčová slova	biomarkers; burden of disease; cognitive dysfunction; magnetic resonance imaging; multiple sclerosis; neurofilament
Popis	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.