Treatment strategies for multiple sclerosis - escalation and induction therapies

Abstract

Introduction and objective Multiple sclerosis (MS) is the most common demyelinating disease. The symptoms resulting from the destruction of the myelin sheaths in the CNS are very diverse. The cause of the disease is not fully understood. Treatment can be divided into symptomatic, relapse treatment and MS modifying treatment. The type and activity of MS determine the choice of a disease-modifying treatment model. There are two main treatment strategies: escalation and induction. The aim of the study is to discuss these strategies and new developments in this area. State of knowledge The escalation strategy consists in initiating therapy with first-line drugs with a known and safest profile of action, and in the absence or obtaining an insufficient response to this treatment, second line drugs are introduced successively. The induction strategy, on the other hand, is sometimes used in patients with high disease activity or its aggressive course. It consists in starting the therapy with strong immunosuppressants in order to inhibit the progress of the disease, and then the effects of the treatment are maintained using safer drugs. The drugs modifying the course of MS include interferons beta, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, natalizumab, mitoxantrone, alemtuzumab, or ocrelizumab. Conclusions Disease-modifying treatments should be individualized for each patient. It is important to activate it quickly, because treatment is most effective in the first years of the disease, and also because MS is diagnosed in young adults and can quickly lead to disability. Despite the increasing possibilities of MS modifying treatments, more research is still needed on newer drugs and the effectiveness of treatment strategies.

Keywords

• immunomodulation
• multiple sclerosis
• escalation therapy
• induction therapy