How to choose initial treatment in multiple sclerosis patients: a case-based approach
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos de neuro-psiquiatria (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700159 |
Resumo: | ABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision. |
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Arquivos de neuro-psiquiatria (Online) |
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How to choose initial treatment in multiple sclerosis patients: a case-based approachMultiple SclerosisTherapeuticsABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision.Academia Brasileira de Neurologia - ABNEURO2022-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700159Arquivos de Neuro-Psiquiatria v.80 n.5 suppl.1 2022reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x-anp-2022-s128info:eu-repo/semantics/openAccessApóstolos,Samira Luisa PereiraBoaventura,MateusMendes,Natalia TrombiniTeixeira,Larissa SilvaCampana,Igor Gusmãoeng2022-08-16T00:00:00Zoai:scielo:S0004-282X2022000700159Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2022-08-16T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse |
dc.title.none.fl_str_mv |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
title |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
spellingShingle |
How to choose initial treatment in multiple sclerosis patients: a case-based approach Apóstolos,Samira Luisa Pereira Multiple Sclerosis Therapeutics |
title_short |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
title_full |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
title_fullStr |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
title_full_unstemmed |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
title_sort |
How to choose initial treatment in multiple sclerosis patients: a case-based approach |
author |
Apóstolos,Samira Luisa Pereira |
author_facet |
Apóstolos,Samira Luisa Pereira Boaventura,Mateus Mendes,Natalia Trombini Teixeira,Larissa Silva Campana,Igor Gusmão |
author_role |
author |
author2 |
Boaventura,Mateus Mendes,Natalia Trombini Teixeira,Larissa Silva Campana,Igor Gusmão |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Apóstolos,Samira Luisa Pereira Boaventura,Mateus Mendes,Natalia Trombini Teixeira,Larissa Silva Campana,Igor Gusmão |
dc.subject.por.fl_str_mv |
Multiple Sclerosis Therapeutics |
topic |
Multiple Sclerosis Therapeutics |
description |
ABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-05-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700159 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2022000700159 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/0004-282x-anp-2022-s128 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Academia Brasileira de Neurologia - ABNEURO |
publisher.none.fl_str_mv |
Academia Brasileira de Neurologia - ABNEURO |
dc.source.none.fl_str_mv |
Arquivos de Neuro-Psiquiatria v.80 n.5 suppl.1 2022 reponame:Arquivos de neuro-psiquiatria (Online) instname:Academia Brasileira de Neurologia instacron:ABNEURO |
instname_str |
Academia Brasileira de Neurologia |
instacron_str |
ABNEURO |
institution |
ABNEURO |
reponame_str |
Arquivos de neuro-psiquiatria (Online) |
collection |
Arquivos de neuro-psiquiatria (Online) |
repository.name.fl_str_mv |
Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia |
repository.mail.fl_str_mv |
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