Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command.
OBJECTIVE: The therapies available today for multiple sclerosis (MS) reduce but do not fully control disease activity. The objective of this article is to review the definitions of and treatments for suboptimally controlled MS and highlight the challenges faced by clinicians to increase awareness of...
| Publicado en: | Current Medical Research & Opinion Vol. 25; no. 10; pp. 2459 - 2471 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Taylor & Francis Ltd
Jan2009
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105165548&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105165548 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03007995 DFY jtl: Current Medical Research & Opinion issn: 03007995 maglogo: N pubinfo: dt: Jan2009 vid: 25 iid: 10 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 105165548 2010616508 10.1185/03007990903158364 NLM19678753 105165548 ppf: 2459 ppct: 12 formats: tig: atl: Recognizing and treating suboptimally controlled multiple sclerosis: steps toward regaining command. aug: au: Freedman MS Cohen B Dhib-Jalbut S Jeffery D Reder AT Sandberg-Wollheim M Weinstock-Guttman B affil: University of Ottawa, Smyth Rd., Ottawa, ON, Canada K1H 8L6. mfreedman@ottawahospital.on.ca sug: subj: Multiple Sclerosis Diagnosis Multiple Sclerosis Therapy Human Multiple Sclerosis Physiopathology ab: OBJECTIVE: The therapies available today for multiple sclerosis (MS) reduce but do not fully control disease activity. The objective of this article is to review the definitions of and treatments for suboptimally controlled MS and highlight the challenges faced by clinicians to increase awareness of recognizing and managing patients with suboptimally controlled MS. METHODS: Published literature describing treatment failure, treatment optimization paradigms or algorithms, clinical studies of therapies in patients with suboptimally controlled MS, or case reports of management of patients with suboptimally controlled MS were identified from searches of EMBASE and MEDLINE. This was supplemented with case reports and discussions from an expert panel meeting of MS specialists focused on the diagnosis and treatment of suboptimally controlled MS. RESULTS: Several groups have created recommendations for evaluating suboptimal response to disease-modifying drugs (DMDs) in MS. Currently no robust evidence-based data exist to guide treatment decisions in patients who have suboptimal response to a particular therapy. In the absence of data, several treatment paradigms for suboptimally controlled MS have been proposed using a step therapy or platform therapy approach. Therapy modifications require consideration of disease- and patient-specific factors while accounting for the risk-benefit profile of the agent(s). Unapproved drugs and combination therapies should be reserved as agents of last resort because of the experimental nature of these treatments. Conclusions: In the absence of evidence-based data, identifying and treating MS patients with suboptimal response to the available platform therapies remains challenging. Developing algorithms able to quantify breakthrough disease activity and suboptimal response to DMDs in individual MS patients remains an important target for the MS community. Consideration should be given for all reasons why a particular DMD may not be working for a given patient and for the use of an individualized step therapy. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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