Smouldering multiple sclerosis: the "real MS"
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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Smouldering multiple sclerosis : the "real MS". / Giovannoni, Gavin; Popescu, Veronica; Wuerfel, Jens; Hellwig, Kerstin; Iacobeus, Ellen; Jensen, Michael B.; García-Domínguez, José Manuel; Sousa, Livia; De Rossi, Nicola; Hupperts, Raymond; Fenu, Giuseppe; Bodini, Benedetta; Kuusisto, Hanna Maija; Stankoff, Bruno; Lycke, Jan; Airas, Laura; Granziera, Cristina; Scalfari, Antonio.
I: Therapeutic Advances in Neurological Disorders, Bind 15, 2022.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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TY - JOUR
T1 - Smouldering multiple sclerosis
T2 - the "real MS"
AU - Giovannoni, Gavin
AU - Popescu, Veronica
AU - Wuerfel, Jens
AU - Hellwig, Kerstin
AU - Iacobeus, Ellen
AU - Jensen, Michael B.
AU - García-Domínguez, José Manuel
AU - Sousa, Livia
AU - De Rossi, Nicola
AU - Hupperts, Raymond
AU - Fenu, Giuseppe
AU - Bodini, Benedetta
AU - Kuusisto, Hanna Maija
AU - Stankoff, Bruno
AU - Lycke, Jan
AU - Airas, Laura
AU - Granziera, Cristina
AU - Scalfari, Antonio
N1 - Publisher Copyright: © The Author(s), 2022.
PY - 2022
Y1 - 2022
N2 - Using a philosophical approach or deductive reasoning, we challenge the dominant clinico-radiological worldview that defines multiple sclerosis (MS) as a focal inflammatory disease of the central nervous system (CNS). We provide a range of evidence to argue that the ‘real MS’ is in fact driven primarily by a smouldering pathological disease process. In natural history studies and clinical trials, relapses and focal activity revealed by magnetic resonance imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs) were found to be poor predictors of long-term disease evolution and were dissociated from disability outcomes. In addition, the progressive accumulation of disability in MS can occur independently of relapse activity from early in the disease course. This scenario is underpinned by a more diffuse smouldering pathological process that may affect the entire CNS. Many putative pathological drivers of smouldering MS can be potentially modified by specific therapeutic strategies, an approach that may have major implications for the management of MS patients. We hypothesise that therapeutically targeting a state of ‘no evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent disability accumulation in MS, meaning that treatment should also focus on other brain and spinal cord pathological processes contributing to the slow loss of neurological function. This should also be complemented with a holistic approach to the management of other systemic disease processes that have been shown to worsen MS outcomes.
AB - Using a philosophical approach or deductive reasoning, we challenge the dominant clinico-radiological worldview that defines multiple sclerosis (MS) as a focal inflammatory disease of the central nervous system (CNS). We provide a range of evidence to argue that the ‘real MS’ is in fact driven primarily by a smouldering pathological disease process. In natural history studies and clinical trials, relapses and focal activity revealed by magnetic resonance imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs) were found to be poor predictors of long-term disease evolution and were dissociated from disability outcomes. In addition, the progressive accumulation of disability in MS can occur independently of relapse activity from early in the disease course. This scenario is underpinned by a more diffuse smouldering pathological process that may affect the entire CNS. Many putative pathological drivers of smouldering MS can be potentially modified by specific therapeutic strategies, an approach that may have major implications for the management of MS patients. We hypothesise that therapeutically targeting a state of ‘no evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent disability accumulation in MS, meaning that treatment should also focus on other brain and spinal cord pathological processes contributing to the slow loss of neurological function. This should also be complemented with a holistic approach to the management of other systemic disease processes that have been shown to worsen MS outcomes.
KW - multiple sclerosis
KW - progression independent of relapse activity
KW - progressive multiple sclerosis
KW - smouldering multiple sclerosis
U2 - 10.1177/17562864211066751
DO - 10.1177/17562864211066751
M3 - Review
C2 - 35096143
AN - SCOPUS:85123704451
VL - 15
JO - Therapeutic Advances in Neurological Disorders
JF - Therapeutic Advances in Neurological Disorders
SN - 1756-2856
ER -
ID: 314845864