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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/19761

Title: Optimizing therapy early in multiple sclerosis: An evidence-based view
Authors: Ziemssen, Tjalf
De Stefano, Nicola
Sormani, Maria Pia
Van Wijmeersch, Bart
Wiendl, Heinz
Kieseier, Bernd C.
Issue Date: 2015
Abstract: Therapies that target the underlying pathology of multiple sclerosis (MS), including focal and diffuse damage, may improve long-term disease control. Focal damage (inflammatory lesions) manifests clinically mainly as relapses, whereas diffuse damage (neurodegeneration and brain volume loss) has been more closely associated with disability progression and cognitive decline. Given that first-line therapies such as beta-interferon and glatiramer acetate, which are primarily directed against inflammation, might fail to adequately control disease activity in some patients, it has been recommended to switch these patients early to a therapy of higher efficacy, possibly targeting both components of MS pathology more rigorously. This review provides an overview of the efficacy of EU-approved disease-modifying therapies on conventional MS outcome measures (relapses, disability progression and paraclinical magnetic resonance imaging endpoints) in addition to brain volume loss, a measure of diffuse damage in the brain. In addition, the evidence supporting early treatment optimization in patients with high disease activity despite first-line therapy will be reviewed and an algorithm for optimal disease control will be presented. (C) 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Notes: [Ziemssen, Tjalf] Tech Univ Dresden, Univ Hosp Carl Gustav Cams, Ctr Clin Neurosci, MS Ctr Dresde,Dept Neurol, D-01307 Dresden, Germany. [De Stefano, Nicola] Univ Siena, Dept Med Surg & Neurosci, I-53100 Siena, Italy. [Sormani, Maria Pia] Univ Genoa, Dept Hlth Sci, I-16126 Genoa, Italy. [Van Wijmeersch, Bart] Hasselt Univ, Inst Biomed, B-3590 Diepenbeek, Belgium. [Van Wijmeersch, Bart] Rehabil & MS Ctr Overpelt, B-3590 Diepenbeek, Belgium. [Wiendl, Heinz] Univ Munster, Dept Neurol, D-48149 Munster, Germany. [Kieseier, Bernd C.] Univ Dusseldorf, Dept Neurol, D-40225 Dusseldorf, Germany.
URI: http://hdl.handle.net/1942/19761
DOI: 10.1016/j.msard.2015.07.007
ISI #: 000362133000014
ISSN: 2211-0348
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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