Guideline for multiple sclerosis treatment in Brazil: Consensus from the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology

Abstract

Multiple sclerosis has become an ever-increasing challenge to neurologists. With the release of the latest medications on the market, Brazilian neurologists feel divided between following their patients’ evolution in accordance with the strict rules established by the Brazilian Ministry of Health regarding drug distribution, or following disease progression and worsening in accordance with the evidence in the literature. Therefore, a systematic review of the main published treatment guidelines was conducted and an escalating therapy proposed for guiding multiple sclerosis patient treatment in Brazil.

Regular Exercise Modifies Histopathological Outcomes of Pharmacological Treatment in Experimental Autoimmune Encephalomyelitis

“…The rationale for changing treatment to immunosuppressive therapies arise from the insufficient reduction of relapses by the immunomodulation strategy ( 1 , 2 ). However, there are evidences in favor of optimizing immunomodulatory response by using behavioral strategies that could enhance the effects of the immunomodulatory DMTs ( 2 , 3 ). Thus, prior physical fitness may affect the response to DMTs in MS patients yielding important beneficial response to the DMTs.…”

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis

“…Also considered for inclusion were DMTs for which a positive phase 2 or 3 trial was available, yet without approval for MS by the aforementioned regulatory agencies, but only in the case of them already being available or approved for another indication in Brazil, in order to maximize the utilization of locallyavailable resources. Previous national recommendations published by the Brazilian Committee on Treatment and Research in Multiple Sclerosis 4,5,6,7 and the Brazilian Academy of Neurology 8,9 were taken into account, as were some key international guidelines 10,11,2 .…”

Autologous Hematopoietic Cell Transplantation in Multiple Sclerosis: Changing Paradigms in the Era of Novel Agents

“…Therefore, updated recommendations regarding the role of AHSCT in the therapeutic algorithm of MS are required in the era of novel agents. Existing guidelines place AHSCT as rescue treatment after failure of second-line treatment along with alemtuzumab and other off-line treatments (ocrelizumab, rituximab) [55]. In addition, the Belgian group most recently recommended AHSCT in aggressive RRMS patients after treatment failure of at least one highly effective treatment (2 courses of alemtuzumab or at least 6 months of treatment with mitoxantrone, cyclophosphamide, natalizumab, rituximab, and ocrelizumab).…”