Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society

• Published in: Croatian medical journal Vol. 63; no. 4; pp. 379 - 388
• Main Authors: Habek, Mario, Adamec, Ivan, Barun, Barbara, Bašić Kes, Vanja, Bogoje Raspopović, Andrijana, Duka Glavor, Klaudia, Gabelić, Tereza, Grzinčić, Tihana, Jukić, Mirjam, Jurašić, Miljenka-Jelena, Kiđemet-Piskač, Spomenka, Komšo, Milica, Rimac, Julija, Lazibat, Ines, Lukić, Branka, Marčinko, Anita, Matijaca, Meri, Ratković, Marija, Šapina, Lidija, Vuletić, Vladimira, Mirošević Zubonja, Tea, Krbot Skorić, Magdalena
• Format: Journal Article
• Language: English
• Published: Sveuciliste U Zagrebu 01.08.2022; Croatian Medical Schools
• Subjects: Care and treatment; Diagnosis; Diseases; Multiple sclerosis; Patient outcomes; Relapse; Review; Croatia
• ISSN: 0353-9504; 1332-8166
• DOI: 10.3325/cmj.2022.63.379

Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present ([greater than or equal to] 9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or [greater than or equal to] 3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse [greater than or equal to] 3), high-efficacy DMT should be initiated. If pwMS experience [greater than or equal to] 1 relapse or [greater than or equal to] 3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS.