TY - JOUR

T1 - Evolving concepts in the treatment of relapsing multiple sclerosis

AU - Comi, Giancarlo

AU - Radaelli, Marta

AU - Soelberg Sørensen, Per

N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.

PY - 2017

Y1 - 2017

N2 - In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.

AB - In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.

KW - Administration, Oral

KW - Antibodies, Monoclonal/administration & dosage

KW - Drug Administration Schedule

KW - Humans

KW - Immunologic Factors/administration & dosage

KW - Immunosuppressive Agents/administration & dosage

KW - Injections, Intravenous

KW - Multiple Sclerosis, Relapsing-Remitting/drug therapy

KW - Secondary Prevention

U2 - 10.1016/S0140-6736(16)32388-1

DO - 10.1016/S0140-6736(16)32388-1

M3 - Review

C2 - 27889192

VL - 389

SP - 1347

EP - 1356

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10076

ER -