ECTRIMS 2021 – Oral Presentations

Abstract

Multiple sclerosis (MS) is a complex disease in which the innate and adaptive immune systems play a fundamental role and treatment with disease-modifying therapies (DMTs) reduces relapses of neurologic symptoms. Immune modulatory therapies have provided novel insights into disease pathology, for example, that long-neglected B cells actually play a relevant role or that early consequent treatment in the relapsing phase of the disease is able to prevent a later conversion into a secondary progressive disease course. When starting or switching treatment, it is essential to continuously monitor patients and perform the necessary laboratory assessment and vaccination status check-currently in particular against SARS-CoV2-as well as a thorough neurological examination and MRI of the brain at regular intervals (Wiendl, Gold . . . Zipp, Multiple Sclerosis Treatment Consensus Group (MSTKG): Position statement on disease modifying therapies for multiple sclerosis (white paper). TAND 2021, in press). Here, we will discuss whether, when and with which monitoring steps MS patients on DMT with poor response to treatment should switch to higher efficacy DMTs versus similar efficacy DMTs. When possible, published evidence should be taken into account, however many questions have not yet been addressed by larger investigations;here, consensus statements should be considered. Efficacy and potential risks as well as the intervals between different treatment regimens should be included in the decision-making process. Novel blood-based biomarkers such as neurofilaments might additionally help in patient treatment stratification (Bittner, Jiwon, Havrdova, Tintore, Zipp, The potential of serum neurofilament as biomarker for multiple sclerosis. Brain 2021). The overall goal is to achieve little-or ideally no-evidence of disease activity and also no progression independent of relapses (PIRA). However, addressing axonal damage in MS remains the largest challenge faced by clinical research and patient care.