Optimizing treatment success in multiple sclerosis.

Area of Science:

• Neuroimmunology
• Clinical Neurology
• Radiology

Background:

• Multiple sclerosis (MS) treatment has advanced, yet progressive disability and mortality remain significant burdens.
• High healthcare and societal costs associated with MS necessitate optimized, early treatment strategies.
• Current treatment paradigms often delay introduction of highly efficacious therapies until first-line treatments fail.

Purpose of the Study:

• To advocate for early treatment optimization in MS using highly efficacious therapies.
• To highlight the emerging strategy of achieving no evidence of disease activity (NEDA) in MS management.
• To emphasize the importance of monitoring brain atrophy as a key indicator of MS progression and treatment efficacy.

Main Methods:

• Review of current multiple sclerosis (MS) treatment strategies and disease-modifying therapies (DMTs).
• Analysis of the correlation between conventional MRI measures and clinical disability in MS.
• Evaluation of MRI-based measures of brain atrophy and their response to different DMTs.
• Discussion of the critical window for early intervention in MS to preserve neurological function.

Main Results:

• Despite advances, MS disability and mortality burdens persist, underscoring the need for optimized treatment.
• No evidence of disease activity (NEDA) is a key goal, requiring regular monitoring of relapses and disability.
• Brain atrophy, assessed by MRI, is a more sensitive marker of neuroaxonal damage than conventional lesion load.
• Available DMTs demonstrate variable effects on slowing brain volume loss, with some, like fingolimod, showing significant benefits.

Conclusions:

• Early intervention with highly efficacious therapies is critical for long-term neurological function and preventing disability in MS.
• Optimizing MS treatment requires regular monitoring and consideration of therapies that effectively reduce brain atrophy.
• New MS therapies and evolving management strategies offer unprecedented opportunities to improve treatment outcomes and patient prognosis.