[Selection and optimization of therapy for progressive type multiple sclerosis]

Area of Science:

• Neurology
• Immunology
• Clinical Therapeutics

Context:

• Progressive multiple sclerosis (MS) encompasses primary progressive MS (PPMS) and secondary progressive MS (SPMS), potentially distinct pathological entities.
• Current treatment options for progressive MS are limited, with a lack of Class I evidence for initiating disease-modifying therapies in PPMS and SPMS.
• Existing treatments offer limited efficacy for the diverse disabilities caused by progressive MS.

Purpose:

• To review the current landscape of progressive multiple sclerosis (MS) treatment.
• To highlight the unmet needs in managing PPMS and SPMS.
• To discuss the potential for future therapeutic strategies, including axonal regeneration and remyelination.

Summary:

• Progressive MS, including PPMS and SPMS, faces significant therapeutic challenges due to limited treatment options and insufficient high-level evidence for current therapies.
• Health-related quality of life (HRQOL) is a critical consideration for patients with progressive MS, necessitating physician attention.
• Emerging treatments targeting axonal regeneration and remyelination hold promise for future management of progressive MS.

Impact:

• This review underscores the urgent need for evidence-based treatment guidelines for progressive MS.
• It emphasizes the importance of prioritizing patient quality of life in clinical practice.
• It provides insight into promising future therapeutic avenues for progressive MS, potentially improving long-term outcomes.