Personalised Therapy for Multiple Sclerosis is Key Factor in Treatment Success

8/13/2019 Personalised Therapy for Multiple Sclerosis is Key Factor in Treatment Success

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ENS 2013: 3,000 neurologists meet in Barcelona

Personalised therapy for multiple sclerosis is key factor intreatment success

Although there are myriad new treatment options for multiple sclerosis, this disease isstill hard to get under control. Experts at the Congress of the European NeurologicalSociety in Barcelona urged massive efforts to be made in pharmacogenetics so that thesuccess and sideeffects of drugs on individuals can be predicted. Newly revised !Streatment guidelines put special emphasis on patientcentred factors for successfultreatments.

Barcelona, 10 une 2013 – “Although the upcoming approval of new drugs against

multiple sclerosis will offer a number of additional treatment options, it is important thatwe keep one thing in mind: The only way we can get this disease well under control is ifwe manage to provide personalised therapy tailored to the individual and to predict theeffects and side-effects of a given drug. nfortunately these efforts are still in the earlystages of development,! "rof #avier $ontalban %$ultiple &clerosis 'entre of 'atalonia,

&pain( e)plained at the *+rd $eeting of the uropean eurological &ociety %&( inarcelona. $ore than +,/// e)perts are currently gathered there to discuss latestdevelopments in their field.

"rof $ontalban urged that more pharmacologic research be done on biomarkers and thatphysicians cooperate more closely with patients to optimise therapy. $ultiple sclerosis%$&( is a chronic inflammatory disease of the central nervous system characterised by a

high degree of heterogeneity. The clinical course of the disease and its degree of severitycan vary widely from one individual to the ne)t. 0t is now known that one and the sametreatment can yield very different therapeutic results. "rof $ontalban: “1espite anawareness of this problem, personalised therapy was not an issue for a long time, not

least because of the lack of options. This situation could well change in the near future.!

!ighly effecti"e drugs #ut a host of risks

2e are seeing the end of a “one drug fits all! approach to multiple sclerosis therapy, said"rof $ontalban. “$yriad new treatment options are becoming established right now.There is a well-founded hope that we will be able to help people suffering from $& more

effectively and more 3uickly in future. 2e were familiar with this disease for 4*/ years

without being able to treat it. 5or 46 years, drugs have been available withoutnoteworthy side-effects but limited in their effectiveness. 0n the meantime a number ofhighly effective drugs have been put on the market. 7owever, they involve risks ranging

from hair loss and bradycardia to progressive multifocal leukoencephalopathy %"$8(. "$8is a dangerous viral infection caused by the immune-suppressive effect of some drugsand can have fatal conse3uences. "rof $ontalban: “0n the meantime a test has been

developed for determining the probability of patients to develop "$8. This is a welcomestep in the right direction. The genetic causes of the varying effectiveness of individualtypes of drugs are becoming increasingly clear.! 0nterferon 9, the first disease-modifyingdrug that was approved, is effective on */ to 66 of patients depending on the criteria

applied. This fact has led science to make great efforts to find biomarkers that reliablyindicate successful treatment and side-effects. "rof $ontalban: “;ight now we are at 4//

possible biomarkers without a clear tendency. This shows how comple) $& research isand how far we still have to go to achieve personalised medicine.!



$anger of changing or stopping therapy

nder certain circumstances, more pharmacogenetic findings could enable e)perts topredict the conse3uences of switching therapies. The medical field remains in the dark onmany aspects of this issue too, to the detriment of those affected. A 'atalonian studypresented at the & $eeting shows how problematic it can be to switch therapies. Afterfive years suffering from $&, the seven study participants were medicated with thehighly effective disease-modifying drug natali<umab because the previous treatment hadfailed. Their state of health remained stable for the average period of about *.6 years

they took this substance. They then had to switch to other weaker drugs for reasonsvarying from "$8 risk to pregnancy and allergic reactions. 1espite the alternativemedication, the patients= neurological state deteriorated 3uickly. After about threemonths, four of the seven sub>ects e)hibited new lesions and two of the seven were even

found to have sustained ?/ new in>uries to the central nervous system. A mere elevenmonths later, all patients had ?/ to @/ new lesions. "rof $ontalban: “2hen patients stoptaking drugs like natali<umab, they can suffer disastrous relapses with a more aggressive

disease than before. 0t is therefore urgent that we devise strategies to ensure greatercontinuity. This task e)tends beyond pharmacogenetics and re3uires a holistic approachto treatment.!

Ne% treatment guidelines take indi"idual factors into account

vidence-based treatment guidelines on $& therapy are now being thoroughly updated ina pro>ect under "rof $ontalban=s aegis and with the support of numerous nationalsocieties in this field. This revision takes account not only of the many pharmacological

innovations such as oral therapies or drugs based on monoclonal antibodies. 0t also putsspecial emphasis on the many individual factors that personalise a therapy and make it

more successful. These factors include thoroughly advising and informing the patientsbefore treatment begins so they can decide on a therapy option and take part in carryingit out. To this end, the new guidelines also provide informational material for patients."rof $ontalban: “0nitially, very fundamental 3uestions have to be clarified: 2hat do

patients consider a successful therapy to be 2hat would they rather accept in thistherapeutic tightrope walk: severe side-effects or early disablement Are womenplanning to have children! The decisive factor after that is to monitor and if need be,

adapt the successful therapy. "rof $ontalban: “To be successful, each therapy decisionmust be made in close consultation with the patients. Today, a patient-centred approachis more possible than ever before. That is because $& breaks out mostly in young adultsaged */ to ?/. As a general rule, this group is digitally competent and can use the

0nternet to keep in constant contact with the physicians treating them. The e)tensiveinvolvement of the patients is especially important with $& to increase compliance.! "rof$ontalban hopes the new guidelines will be implemented 3uickly and create greater

awareness for personalised therapy options amongst general practitioners andneurologists.

Sources: & Abstract " @4/: 1evelopment of a clinical practice guideline on the management of multiplesclerosis using the B;A1 methodological approachC & Abstract 4DE: "ersonalised treatment of $ultiple&clerosis: &afetyC & Abstract 4@4: "ersonalised treatment of $ultiple &clerosis: &hared decision-making andpatient-centred careC & Abstract F*+4: 'atastrophic multiple sclerosis rebound after natali<umab treatmentdiscontinuationC 'omabella, $anuelG$ontalban, #avier %*/4*(: “$ultiple sclerosis and immunological response:time for a personalised therapy! in: 7ot Topics in eurology and "sychiatry */4*C 4+, pp.4E-*6

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Personalised Therapy for Multiple Sclerosis is Key Factor in Treatment Success