Brain health: time matters in multiple sclerosis

We present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families. Structured discussions and lit...

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Veröffentlicht in:	Multiple sclerosis and related disorders Jg. 9; S. S5 - S48
Hauptverfasser:	Giovannoni, Gavin, Butzkueven, Helmut, Dhib-Jalbut, Suhayl, Hobart, Jeremy, Kobelt, Gisela, Pepper, George, Sormani, Maria Pia, Thalheim, Christoph, Traboulsee, Anthony, Vollmer, Timothy
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Netherlands Elsevier B.V 01.09.2016
Schlagworte:	Brain - physiopathology Consensus statement Disease activity Disease-modifying therapy (DMT) Humans Magnetic resonance imaging (MRI) Multiple sclerosis Multiple Sclerosis - diagnosis Multiple Sclerosis - economics Multiple Sclerosis - physiopathology Multiple Sclerosis - therapy Neurology Time Factors Treatment strategy RRMS Treatment strategy FDA RCT Multiple sclerosis NRSPMS PPMS MRI CNS ABN Consensus statement AUD NEDA EMA US EDSS RWE Disease-modifying therapy (DMT) Disease activity SPMS MS Magnetic resonance imaging (MRI) GP DMT CIS € AAN HTA QALY EUReMS RIS MoA RSPMS health technology assessment US dollars Australian dollars general practitoner (family or primary care physician) disease activity secondary progressive multiple sclerosis disease-modifying therapy (DMT) relapsing–remitting multiple sclerosis Food and Drug Administration (the US regulatory authority) American Academy of Neurology central nervous system consensus statement primary progressive multiple sclerosis relapsing secondary progressive multiple sclerosis disease-modifying therapy Association of British Neurologists magnetic resonance imaging real-world evidence no evidence of disease activity RICT radiologically isolated syndrome non-relapsing secondary progressive multiple sclerosis euros treatment strategy multiple sclerosis mechanism of action Kurtzke Expanded Disability Status Scale quality-adjusted life year randomized controlled trial European Register for Multiple Sclerosis magnetic resonance imaging (MRI) European Medicines Agency (the European regulatory authority) clinically isolated syndrome
ISSN:	2211-0348, 2211-0356
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Zusammenfassung:	We present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families. Structured discussions and literature searches conducted in 2015 examined the personal and economic impact of MS, current practice in diagnosis, treatment and management, definitions of disease activity and barriers to accessing disease-modifying therapies (DMTs). Delays often occur before a person with symptoms suggestive of MS sees a neurologist. Campaigns to raise awareness of MS are needed, as are initiatives to improve access to MS healthcare professionals and services. We recommend a clear treatment goal: to maximize neurological reserve, cognitive function and physical function by reducing disease activity. Treatment should start early, with DMT and lifestyle measures. All parameters that predict relapses and disability progression should be included in the definition of disease activity and monitored regularly when practical. On suboptimal control of disease activity, switching to a DMT with a different mechanism of action should be considered. A shared decision-making process that embodies dialogue and considers all appropriate DMTs should be implemented. Monitoring data should be recorded formally in registries to generate real-world evidence. In many jurisdictions, access to DMTs is limited. To improve treatment access the relevant bodies should consider all costs to all parties when conducting economic evaluations and encourage the continuing investigation, development and use of cost-effective therapeutic strategies and alternative financing models. The consensus findings of an international author group recommend a therapeutic strategy based on proactive monitoring and shared decision-making in MS. Early diagnosis and improved treatment access are also key components. [Display omitted] •Consensus recommendations on MS diagnosis, management and treatment are presented.•Neurological reserve, a component of brain health, can compensate for CNS damage.•We propose a therapeutic strategy that aims to maximize lifelong brain health.•Proactive monitoring, shared decision-making and improved treatment access are key.•Early referral, diagnosis and treatment initiation are also of crucial importance.
Bibliographie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	2211-0348 2211-0356
DOI:	10.1016/j.msard.2016.07.003