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Journal of Neurology
Published in: Journal of Neurology 10/2022

Open Access 24-05-2022 | Magnetic Resonance Imaging | Original Communication

Early use of high-efficacy disease‑modifying therapies makes the difference in people with multiple sclerosis: an expert opinion

Authors: Massimo Filippi, Maria Pia Amato, Diego Centonze, Paolo Gallo, Claudio Gasperini, Matilde Inglese, Francesco Patti, Carlo Pozzilli, Paolo Preziosa, Maria Trojano

Published in: Journal of Neurology | Issue 10/2022

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Abstract

Multiple sclerosis (MS) is a chronic and progressive neurological disease that is characterized by neuroinflammation, demyelination and neurodegeneration occurring from the earliest phases of the disease and that may be underestimated. MS patients accumulate disability through relapse-associated worsening or progression independent of relapse activity. Early intervention with high-efficacy disease-modifying therapies (HE-DMTs) may represent the best window of opportunity to delay irreversible central nervous system damage and MS-related disability progression by hindering underlying heterogeneous pathophysiological processes contributing to disability progression. In line with this, growing evidence suggests that early use of HE-DMTs is associated with a significant greater reduction not only of inflammatory activity (clinical relapses and new lesion formation at magnetic resonance imaging) but also of disease progression, in terms of accumulation of irreversible clinical disability and neurodegeneration compared to delayed HE-DMT use or escalation strategy. These beneficial effects seem to be associated with acceptable long-term safety risks, thus configuring this treatment approach as that with the most positive benefit/risk profile. Accordingly, it should be mandatory to treat people with MS early with HE-DMTs in case of prognostic factors suggestive of aggressive disease, and it may be advisable to offer an HE-DMT to MS patients early after diagnosis, taking into account drug safety profile, disease severity, clinical and/or radiological activity, and patient-related factors, including possible comorbidities, family planning, and patients’ preference in agreement with the EAN/ECTRIMS and AAN guidelines. Barriers for an early use of HE-DMTs include concerns for long-term safety, challenges in the management of treatment initiation and monitoring, negative MS patients’ preferences, restricted access to HE-DMTs according to guidelines and regulatory rules, and sustainability. However, these barriers do not apply to each HE-DMT and none of these appear insuperable.
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Metadata
Title
Early use of high-efficacy disease‑modifying therapies makes the difference in people with multiple sclerosis: an expert opinion
Authors
Massimo Filippi
Maria Pia Amato
Diego Centonze
Paolo Gallo
Claudio Gasperini
Matilde Inglese
Francesco Patti
Carlo Pozzilli
Paolo Preziosa
Maria Trojano
Publication date
24-05-2022
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 10/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-022-11193-w

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