Contributions
Abstract: 69
Type: Oral
With the availability of a broad range of drugs that modify disease course, the usual treatment algorithm of starting with platform therapies and subsequently escalade as needed has been questioned. These drugs have a modest effect on disease course on average, but can control very well the clinical and MRI activity in some patients with an excellent long-term safety profile. The newer treatment strategies for MS alter or suppress the immune response in a more dramatic way. As such, they have been associated with a higher risk of opportunistic infections, some of which can be fatal. The long-term safety of these newer treatment strategies remains to be determined as overall limited numbers of patients have been treated worldwide for limited periods of time, and some strategies such as bone marrow transplant have mostly been studied without a control group. Furthermore, there are very little randomized data compared to placebo or platform therapy regarding the early use of the most potent agents, and there is virtually no large trial of induction therapy that has been done in MS. As such, it is unclear if the more potent agents are beneficial and safe to be used for induction early in disease course. Finally, only a few of the highly effective treatment strategies for MS alter the immune response in a way that would provide a good rational to use them as induction therapy with the hope to have induce extended disease remission. Taken together, these facts suggest that for most patients with MS we should not consider potent induction early in the disease course, and rather design carefully large trials of induction with the drugs most likely able to achieve this goal so we can put this debate to rest.
Disclosure: Nothing to disclose
Abstract: 69
Type: Oral
With the availability of a broad range of drugs that modify disease course, the usual treatment algorithm of starting with platform therapies and subsequently escalade as needed has been questioned. These drugs have a modest effect on disease course on average, but can control very well the clinical and MRI activity in some patients with an excellent long-term safety profile. The newer treatment strategies for MS alter or suppress the immune response in a more dramatic way. As such, they have been associated with a higher risk of opportunistic infections, some of which can be fatal. The long-term safety of these newer treatment strategies remains to be determined as overall limited numbers of patients have been treated worldwide for limited periods of time, and some strategies such as bone marrow transplant have mostly been studied without a control group. Furthermore, there are very little randomized data compared to placebo or platform therapy regarding the early use of the most potent agents, and there is virtually no large trial of induction therapy that has been done in MS. As such, it is unclear if the more potent agents are beneficial and safe to be used for induction early in disease course. Finally, only a few of the highly effective treatment strategies for MS alter the immune response in a way that would provide a good rational to use them as induction therapy with the hope to have induce extended disease remission. Taken together, these facts suggest that for most patients with MS we should not consider potent induction early in the disease course, and rather design carefully large trials of induction with the drugs most likely able to achieve this goal so we can put this debate to rest.
Disclosure: Nothing to disclose