How to reduce the delay of diagnosing secondary progression in multiple sclerosis

Inojosa, Hernán; Ziemssen, Tjalf

doi:10.1177/1352458520943799

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…the MS progression discussion tool). 63,64 The recommendations of a Canadian work group have also addressed this point discussing the described lack of consensus on definition of an adequate treatment response. 10 This group presented minor and major criteria for a therapy switch according to relapse rate, severity, recovery, as well as MRI criteria.…”

Section: Check the Strategy Continuously And Recognize The Opponents'...mentioning

confidence: 99%

The need for a strategic therapeutic approach: multiple sclerosis in check

Inojosa

Proschmann

Akgün

et al. 2022

Therapeutic Advances in Chronic Disease

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Multiple sclerosis (MS) is the most common chronic autoimmune neurological disease. Its therapeutic management has drastically evolved in the recent years with the development of specific disease-modifying therapies (DMTs). Together with the established injectables, oral and intravenous alternatives are now available for MS patients with significant benefits to modulate the disease course. Certain drugs present with a higher efficacy than the others, profiles and frequencies of adverse events differentiate as well. Thus due to the several and different treatment alternatives, the therapeutic approach adopted by neurologists requires a tactical focus for a targeted, timed, and meaningful treatment decision. An integration of rational and emotional control with proper communication skills is necessary for shared decision-making with patients. In this perspective paper, we reinforce the necessary concept of strategic MS treatment approach using all available therapies based on scientific evidence and current experience. We apply a didactic analogy to the strategic game chess. The opening with oriented attack (i.e. already in early disease stages as clinical isolated syndrome), a correct choice of chess pieces to move (i.e. among the several DMTs), a re-assessment reaction to different scenarios (e.g. sustained disease activity, adverse events, and family planning) and the advantage of real-world data are discussed to try the best approach to ultimately successfully approach the best personalized MS treatment.

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Section: Check the Strategy Continuously And Recognize The Opponents'...mentioning

confidence: 99%

The need for a strategic therapeutic approach: multiple sclerosis in check

Inojosa

Proschmann

Akgün

et al. 2022

Therapeutic Advances in Chronic Disease

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“…The time for transition from RRMS to SPMS (if it occurs) is highly variable [ 1 , 8 , 9 ], and a finite window of opportunity to identify subtle signs of progression and implement timely treatment adjustment is unique in every patient [ 26 ]. Rapid identification of MS disease progression is therefore key to facilitating treatment decisions and improving long-term prognosis [ 29 , 30 ]. Nonetheless, currently there is no consensus on the criteria to define disability progression, with various definitions being used in clinical trials [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

“…In clinical practice, patients are retrospectively diagnosed with SPMS following a period of clear progression over 6–12 months, resulting in a diagnostic delay of up to 3–4 years [ 6 , 30 ]. This delay can lead to brain and spinal cord damage with clear clinical consequences, including irreversible physical and mental disabilities and a significant negative impact on quality of life (QoL) [ 27 , 29 ]. When considering how to successfully monitor patients and identify progression, the limitations of existing tools, the lack of useful biological markers, and the heterogeneity of the signs of progression place a high level of importance on clinical evaluation, which represents a considerable challenge for neurologists [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression

Ziemssen

Vandercappellen

Mondragon

et al. 2022

JCM

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This article describes the rationale for the development of the MSProDiscuss™ clinical decision support (CDS) tool, its development, and insights into how it can help neurologists improve care for patients with multiple sclerosis (MS). MS is a progressive disease characterized by heterogeneous symptoms and variable disease course. There is growing consensus that MS exists on a continuum, with overlap between relapsing–remitting and secondary progressive phenotypes. Evidence demonstrates that neuroaxonal loss occurs from the outset, that progression can occur independent of relapse activity, and that continuous underlying pathological processes may not be reflected by inflammatory activity indicative of the patient’s immune response. Early intervention can benefit patients, and there is a need for a tool that assists physicians in rapidly identifying subtle signs of MS progression. MSProDiscuss, developed with physicians and patients, facilitates a structured approach to patient consultations. It analyzes multidimensional data via an algorithm to estimate the likelihood of progression (the MSProDiscuss score), the contribution of various symptoms, and the impact of symptoms on daily living, enabling a more personalized approach to treatment and disease management. Data from CDS tools such as MSProDiscuss offer new insights into disease course and facilitate informed decision-making and a holistic approach to MS patient care.

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“…Um eine mögliche SPMS-Konversion frühzeitig anamnetisch detektieren zu können [33], müssen jedoch Patient und Neurologe in der Lage sein, die frühen Hinwei-se und oft unklaren Anzeichen während der regulären Visite zu kommunizieren bzw. diese zu erfragen [34].…”

Section: Introductionunclassified

MSProDiscuss – Entwicklung eines digitalen Tools zur standardisierten Patientenanamnese, um Progredienz bei Multipler Sklerose zu identifizieren

Inojosa

Akgün

Haacke

et al. 2021

Fortschr Neurol Psychiatr

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ZusammenfassungDie Mehrheit der Patienten mit schubförmiger remittierender Multipler Sklerose (RRMS) konvertiert im langfristigen Verlauf ihrer Erkrankung zu einer sekundär-progredienten Verlaufsform (SPMS), die durch eine schubunabhängige Behinderungszunahme charakterisiert und mit einer deutlich schlechteren Prognose assoziiert ist. Aufgrund der Heterogenität der SPMS-Transition ist dieser Übergang nur schwer feststellbar, daher wird in der Regel eine SPMS-Diagnose nur retrospektiv und oft mit mehrjähriger Verzögerung gestellt. In dieser Übersichtsarbeit stellen wir Ansätze für eine frühere SPMS-Diagnose wie das SPMS-Nomogramm, den MS Prediction Score oder den Best Definition Ansatz vor, die beitragen könnten, die Phase der diagnostischen Unsicherheit zu verkürzen. Im Fokus dieser Übersichtsarbeit steht die Entwicklung von MSProDiscuss, einem neuen webbasierten Tool, durch das der Arzt systematisch und während der Routineanamnese alle progressionsrelevanten Parameter der Krankheitsaktivität, Symptomatik und täglichen Beeinträchtigungen aus Patientenperspektive erheben kann. In einer aktuellen Validierungsstudie zeigte MSProDiscuss eine hohe Sensitivität, Spezifität und Interrater-Reliabilität bei der Identifizierung von SPMS-Patienten und Patienten im SPMS-Übergang. Da MSProDiscuss aufgrund des geringen Zeitbedarfs zu keiner Mehrbelastung des behandelnden Neurologen führt und sein Ergebnis mittels eines einfachen Ampelsystems leicht interpretiert werden kann, wurde es in ersten Usability-Tests als äußerst hilfreiches diagnostisches Werkzeug für die neurologische Praxis bewertet. Die frühzeitige Identifizierung von signifikanter klinischer Progression durch diagnostische Tools wie MSProDiscuss könnte beitragen, ein Zeitfenster für mögliche therapeutische Interventionen zu öffnen.

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How to reduce the delay of diagnosing secondary progression in multiple sclerosis

Cited by 4 publications

References 9 publications

The need for a strategic therapeutic approach: multiple sclerosis in check

The need for a strategic therapeutic approach: multiple sclerosis in check

MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression

MSProDiscuss – Entwicklung eines digitalen Tools zur standardisierten Patientenanamnese, um Progredienz bei Multipler Sklerose zu identifizieren

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