Aggressive multiple sclerosis: proposed definition and treatment algorithm

• Published in: Nature reviews. Neurology Vol. 11; no. 7; pp. 379 - 389
• Main Authors: Rush, Carolina A., MacLean, Heather J., Freedman, Mark S.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2015; Nature Publishing Group
• Subjects: 692/53/2422; 692/617/375/1411/1666; 692/700/565/1436/1437; 692/700/565/251/1574; Advisors; Algorithms; Antineoplastic Agents - therapeutic use; Care and treatment; Disease Progression; Humans; Immunosuppressive Agents - therapeutic use; Medical research; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis, Chronic Progressive - classification; Multiple Sclerosis, Chronic Progressive - therapy; Neurodegeneration; Neurology; Precision medicine; review-article
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/nrneurol.2015.85

Key Points Patients with aggressive multiple sclerosis (MS) are at increased risk of rapid accrual of disability and disease progression, so early detection is critical The window of opportunity for treating patients with aggressive MS is narrow, thus, conventional treatment paradigms need to be reconsidered Aggressive disease warrants aggressive treatment Therapeutic agents vary extensively throughout the world in terms of their availability, licensing, usage experience and logistics of implementation Diligent monitoring is crucial for the timely discovery of suboptimal response to therapy A subset of patients with multiple sclerosis (MS) demonstrate rapid accumulation of disability, and symptoms that are refractory to standard disease-modifying therapies. Rush and colleagues present criteria for identifying patients with so-called aggressive MS, and outline the efficacy of various therapies in this group of patients. The authors emphasize the need to act quickly with these patients, and propose a treatment algorithm to aid clinical decision-making. Multiple sclerosis (MS) is a CNS disorder characterized by inflammation, demyelination and neurodegeneration, and is the most common cause of acquired nontraumatic neurological disability in young adults. The course of the disease varies between individuals: some patients accumulate minimal disability over their lives, whereas others experience a rapidly disabling disease course. This latter subset of patients, whose MS is marked by the rampant progression of disability over a short time period, is often referred to as having 'aggressive' MS. Treatment of patients with aggressive MS is challenging, and optimal strategies have yet to be defined. It is important to identify patients who are at risk of aggressive MS as early as possible and implement an effective treatment strategy. Early intervention might protect patients from irreversible damage and disability, and prevent the development of a secondary progressive course, which thus far lacks effective therapy.