Aggressive multiple sclerosis (2): Treatment

Abstract

The natural history of multiple sclerosis (MS) is highly heterogeneous. A subgroup of patients has what might be termed aggressive MS. These patients may have frequent, severe relapses with incomplete recovery and are at risk of developing greater and permanent disability at the earlier stages of the disease. Their therapeutic window of opportunity may be narrow, and while it is generally considered that they will benefit from starting early with a highly efficacious treatment, a unified definition of aggressive MS does not exist and data on its treatment are largely lacking. Based on discussions at an international focused workshop sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), we review our current knowledge about treatment of individuals with aggressive MS. We analyse the available evidence, identify gaps in knowledge and suggest future research needed to fill those gaps. A companion paper details the difficulties in developing a consensus about what defines aggressive MS.

Epidemiology and therapeutic management of highly active relapsing-remitting multiple sclerosis adults in the French national health insurance database

“…This highlights the need for additional HE-DMD options, as they should be initiated as early as possible. 7,11 Patients who have not been observed to have taking HE-DMD could be relying on other treatments (DMD, symptomatic treatments, other immunosuppressants, rituximab and mitoxantrone) or perhaps be refusing HE-DMD due to several reasons (not available in the claims database): suboptimal e cacy, tolerability issues, or concern about potential tolerability issue. 9 Another possibility is that, despite using multiple criteria and having been validated by experts, our algorithm also detects a small proportion of MS patients who experience at least one relapse, have an MRI, a DMD and a switch of DMD, and yet do not have an HA-RRMS.…”

“…2,10 However, none of these studies described HA-RRMS patients, whose disease management is more complex and still being debated. 11 Furthermore, most of these studies had a short follow-up period (1 year). Therefore, a nationallevel retrospective cohort study was set up, using NHI data, to describe incident HA-RRMS adult patients living in France, over 2010-2015, and their disease management, and followed them up until 2017.…”

Current and emerging disease‐modulatory therapies and treatment targets for multiple sclerosis

“…In contrast, no treatment‐related mortality was detected in a recent nationwide registry‐linkage study of a contemporary cohort, however, finding a long‐lasting effect on infection risk [116]. In current guidelines, AHSCT is considered an experimental treatment option for younger patients with high inflammatory activity, usually in context of an insufficient response to regular high effective DMTs, and a limited accumulated level of disability [117].…”

Economic burden of highly active relapsing-remitting multiple sclerosis patients in the French national health insurance database

“…MS is classified into relapsing or progressive forms, with Relapsing-Remitting MS (RRMS) accounting for 85% to 90% of all initial diagnoses [3]. There is yet a group of patients which remains difficult to define and for which there is no consensus about their treatment [4][5][6]. These patients have frequent relapses and/or Magnetic Resonance Imaging (MRI) activity (either when untreated or while on a Disease-Modifying Therapy [DMT]) and have what might be termed as a Highly Active RRMS (HA-RRMS) [5,7].…”