| Abstract [eng] |
Therapeutic options for multiple sclerosis have increased dramatically in recent decades, with more than twenty drugs acting through different pathophysiological mechanisms to control exacerbations and slow the progression of disability. Choosing the right treatment is a matter of balancing the efficacy of the drug with the safety of the drug - potential adverse reactions. Two strategies are used for the treatment of relapsing-remitting multiple sclerosis: the escalation strategy, which starts treatment with moderately effective drugs that are well tolerated and have well-studied safety profiles, and the early high-intensity strategy, which relies on the early prescription of highly effective drugs in an attempt to suppress the inflammatory mechanism of multiple sclerosis injury as effectively as possible, but also increases the patient's risk of developing severe adverse reactions. 4-15% of relapsing-remitting multiple sclerosis patients have a very aggressive course of the disease, characterised by a sudden accumulation of deficits in physical and cognitive functions. They are characterised by rapid progression of permanent disability, frequent disabling exacerbations, incomplete recovery of exacerbation-related loss of function, and signs of high disease activity on magnetic resonance imaging. All of these features are detected while the patient is managed with disease-modifying therapies. These features are indicative of an aggressive or very aggressive form of multiple sclerosis, but there is still a lack of scientific consensus on the exact definition of this sub-form and on diagnostic and treatment guidelines. There is a growing body of evidence indicating that the early stages of multiple sclerosis are the most important "window of opportunity" period, at which point highly effective disease-modifying therapies have the greatest effect on long-term patient outcomes. Clinical and paraclinical indicators are being sought that can reliably predict aggressive disease early in the course of the disease, thus enabling early prescription of appropriate treatment regime. The view that such criteria are of paramount importance is underlined, as early diagnosis can be crucial for the long-term progression of disability in patients. This paper describes and analyses clinical cases of early intensive treatment of multiple sclerosis. |
