Neurol. praxi. 2023;24(6):469-473 | DOI: 10.36290/neu.2023.074

Early high­ efficacy mulitple sclerosis treatment: therapeutic success despite safety barriers

MUDr. Dominika ©»astná, Ph.D.1, prof. MUDr. Manuela Vaněčková, Ph.D.2, doc. MUDr. Dana Horáková, Ph.D.1
1 Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze
2 Oddělení MR, Radiodiagnostická klinika, 1. LF UK a VFN v Praze

The presented case report illustrates the use of high-efficacy therapy in the early stages of multiple sclerosis as an effective strategy. Numerous studies from real clinical practice confirm the superior effectiveness of this approach. However, in addition to the effectiveness of the therapy, it is crucial to monitor side effects and to intervene early. With the expanding range of disease-modifying therapies (DMT), the appropriate sequencing of individual drugs is another pressing issue. For patients treated with some DMT (S1P modulators, natalizumab) the risk of rebound phenomenon should also be considered when looking for subsequent therapy. One option that appears to be appropriate from the available data is the initiation of ocrelizumab. Non-pharmacological approaches must not be forgotten in the management of therapy, too.

Keywords: multiple sclerosis, high efficacy therapy, disease­‑modifying therapy, ocrelizumab, natalizumab, adverse effects, safety, reimbursement criteria.

Accepted: December 1, 2023; Published: December 7, 2023  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
©»astná D, Vaněčková M, Horáková D. Early high­ efficacy mulitple sclerosis treatment: therapeutic success despite safety barriers. Neurol. praxi. 2023;24(6):469-473. doi: 10.36290/neu.2023.074.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Boz C, Ozakbas S, Terzi M, et al. The comparative effectiveness of fingolimod, natalizumab, and ocrelizumab in relapsing­‑remitting multiple sclerosis. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2023;44(6):2121-2129. https://doi.org/10.1007/S10072-023-06608-Z. Go to original source... Go to PubMed...
    2. Brown JWL, Coles A, Horakova D, et al. Association of Initial Disease­‑Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis. JAMA. 2019;321(2):175-187. https://doi.org/10.1001/JAMA.2018.20588. Go to original source... Go to PubMed...
    3. Debouverie M, Pittion­‑Vouyovitch S, Louis S, et al. Natural history of multiple sclerosis in a population­‑based cohort. European Journal of Neurology. 2008;15(9):916-921. https://doi.org/10.1111/J.1468-1331.2008.02241.X. Go to original source... Go to PubMed...
    4. Determining the Effectiveness of earLy Intensive Versus Escalation Approaches for RRMS - Full Text View - ClinicalTrials.gov. (n.d.). Retrieved April 24, 2022, from https://clinicaltrials.gov/ct2/show/NCT03535298.
    5. Dong­‑Si T, Richman S, Wattjes MP, et al. Outcome and survival of asymptomatic PML in natalizumab­‑treated MS patients. Annals of Clinical and Translational Neurology. 2014;1(10):755-764. https://doi.org/10.1002/ACN3.114. Go to original source... Go to PubMed...
    6. Fuentes­‑Rumí L, Hernández­‑Clares R, Carreón­‑Guarnizo E, et al. Prevention of rebound effect after natalizumab withdrawal in multiple sclerosis. Study of two high­‑dose methylprednisolone schedules. Multiple Sclerosis and Related Disorders. 2020;44:102311. https://doi.org/10.1016/J.MSARD.2020.102311. Go to original source... Go to PubMed...
    7. Goncuoglu C, Tuncer A, Bayraktar­‑Ekincioglu A, et al. Factors associated with fingolimod rebound: A single center real­‑life experience. Multiple Sclerosis and Related Disorders. 2021;56:103278. https://doi.org/10.1016/J.MSARD.2021.103278. Go to original source... Go to PubMed...
    8. Harding K, Williams O, Willis M, et al. Clinical Outcomes of Escalation vs Early Intensive Disease­‑Modifying Therapy in Patients With Multiple Sclerosis. JAMA Neurology. 2019;76(5):536-541. https://doi.org/10.1001/JAMANEUROL.2018.4905. Go to original source... Go to PubMed...
    9. He A, Merkel B, Brown JWL, et al. Timing of high­‑efficacy therapy for multiple sclerosis: a retrospective observational cohort study. The Lancet. Neurology. 2020;19(4):307-316. https://doi.org/10.1016/S1474-4422(20)30067-3. Go to original source... Go to PubMed...
    10. Ho PR, Koendgen H, Campbell N, et al. Risk of natalizumab­‑associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: a retrospective analysis of data from four clinical studies. The Lancet. Neurology. 2017;16(11):925-933. https://doi.org/10.1016/S1474-4422(17)30282-X. Go to original source... Go to PubMed...
    11. Hrnciarova T, Drahota J, Spelman T, et al. Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing­‑remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries. Multiple Sclerosis and Related Disorders. 2023;76. https://doi.org/10.1016/J.MSARD.2023.104803. Go to original source... Go to PubMed...
    12. Kim T, Brinker A, Croteau D, et al. Immune­‑mediated colitis associated with ocrelizumab: a new safety risk. Multiple Sclerosis (Houndmills, Basingstoke, England). 2023;29(10):1275-1281. https://doi.org/10.1177/13524585231195854. Go to original source... Go to PubMed...
    13. Nielsen NM, Westergaard T, Rostgaard K, et al. Familial risk of multiple sclerosis: a nationwide cohort study. American Journal of Epidemiology. 2005;162(8):774-8. https://doi: 10.1093/aje/kwi280. Go to original source... Go to PubMed...
    14. Vaněčková M, Horáková D. Role magnetické rezonance při detekci oportunních infekcí v souvislosti s léčbou roztrouąené sklerózy. Neurol. praxi. 2016;17(6):377-383. https://doi.org/10.36290/NEU.2016.080. Go to original source...
    15. Prosperini L, Mancinelli CR, Solaro CM, et al. Induction Versus Escalation in Multiple Sclerosis: A 10-Year Real World Study. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics. 2020;17(3):994-1004. https://doi.org/10.1007/S13311-020-00847-0. Go to original source... Go to PubMed...
    16. Ryerson LZ, Foley J, Chang I, et al. Risk of natalizumab­‑associated PML in patients with MS is reduced with extended interval dosing. Neurology. 2019;93(15):e1452-e1462. https://doi.org/10.1212/WNL.0000000000008243. Go to original source... Go to PubMed...
    17. Sørensen PS, Bertolotto A, Edan G, et al. Risk stratification for progressive multifocal leukoencephalopathy in patients treated with natalizumab. Multiple Sclerosis (Houndmills, Basingstoke, England). 2012;18(2):143-152. https://doi.org/10.1177/1352458511435105. Go to original source... Go to PubMed...
    18. Spelman T, Magyari M, Piehl F, et al. Treatment Escalation vs. Immediate Initiation of Highly Effective Treatment for Patients With Relapsing­‑Remitting Multiple Sclerosis: Data From 2 Different National Strategies. JAMA Neurology. 2021;78(10):1197-1204. https://doi.org/10.1001/JAMANEUROL.2021.2738. Go to original source... Go to PubMed...
    19. Stastna D, Drahota J, Lauer M, et al. The Czech National MS Registry (ReMuS): Data trends in multiple sclerosis patients whose first disease­‑modifying therapies were initiated from 2013 to 2021. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2023. https://doi.org/10.5507/BP.2023.015. Go to original source...
    20. ©»astná D, Menkyová I, Horáková D. Okrelizumab jiľ od první ataky roztrouąené sklerózy - milník v úhradových kritériích. Neurol. praxi. 2022;23(4):312-316. https://doi.org/10.36290/NEU.2022.030. Go to original source...
    21. ©»astná D, Seňavová J, Andělová M, et al. Internal comorbidities and complications of multiple sclerosis therapy - don't be caught off guard! Vnitrni Lekarstvi. 2023;69(5):294-298. https://doi.org/10.36290/VNL.2023.058. Go to original source... Go to PubMed...
    22. Traditional Versus Early Aggressive Therapy for Multiple Sclerosis Trial - Full Text View - ClinicalTrials.gov. (n.d.). Retrieved April 24, 2022. Available from https://clinicaltrials.gov/ct2/show/NCT03500328.
    23. Uher T, Krasensky J, Malpas C, et al. Evolution of Brain Volume Loss Rates in Early Stages of Multiple Sclerosis. Neurology(R) Neuroimmunology & Neuroinflammation. 2021;8(3). https://doi.org/10.1212/NXI.0000000000000979. Go to original source... Go to PubMed...
    24. Vaněčková M, Martinková A, Tupý R, et al. The spectrum of MRI findings of progressive multifocal leukoencephalopathy in patients with multiple sclerosis in the Czech Republic. Ceska a Slovenska Neurologie a Neurochirurgie. 2019;82(4):381-390. https://doi.org/10.14735/AMCSNN2019381. Go to original source...
    25. Zhu C, Kalincik T, Horakova D, et al. Comparison Between Dimethyl Fumarate, Fingolimod, and Ocrelizumab After Natalizumab Cessation. JAMA Neurology. 2023;80(7):739-748. https://doi.org/10.1001/JAMANEUROL.2023.1542. Go to original source... Go to PubMed...

    Return to the content


    Neurology for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.