About the advantage of induction therapy over escalation therapy in multiple sclerosis Review article
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Published:
Dec 31, 2020
Keywords:
multiple sclerosis, induction therapy
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Abstract
The treatment landscape of multiple sclerosis shifted significantly in the last years with the approval of over 10 new medications over the past decade alone. But to this day no consensus has been achieved regarding which treatments should be used at first choice and recently published international consensus guidelines differing. An escalation or induction approach is considered when treating a patient early in the disease course. An escalator prioritizes safety, whereas an inducer would favor efficacy. A number of thoughtful articles considering whether higher efficacy agents should be used early have been published. The article presents arguments for the superiority of induction therapy over escalation therapy.
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References
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19. He A, Merkel B, Brown JWL et al. Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol. 2020; 19(4): 307-16. https://doi.org/10.1016/S1474-4422(20)30067-3.
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2. Vukusic S, Confavreux C. Natural history of multiple sclerosis: risk factors and prognostic indicators. Curr Opin Neurol. 2007; 20: 269-74.
3. Confavreux C, Vukusic S, Adeleine P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic proces. Brain. 2003; 126: 770-82.
4. Langer-Gould A, Popat RA, Huang SM et al. Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. Arch Neurol. 2006; 63: 1686-91.
5. Giovannoni G, Bermel R, Phillips T et al. Mult Scler Relat Disord. A brief history of NEDA. 2018; 20: 228-30.
6. Calabrese M, Romualdi C, Poretto V et al. The changing clinical course of multiple sclerosis: a matter of gray matter. Ann Neurol. 2013; 74: 76-83.
7. Comabella M, Montalban X. Body fluid biomarkers in multiple sclerosis. Lancet Neurol. 2014; 13: 113-26.
8. Håkansson I, Tisell A, Cassel P et al. Neurofilament light chain in cerebrospinal fluid and prediction of disease activity in clinically isolated syndrome and relapsing-remitting multiple sclerosis. Eur J Neurol. 2017; 24: 703-12.
9. Fillippi M, Rocca M. Rethinking multiple sclerosis treatment strategies. Lancet Neurol. 2020; 19(4): 281-2. https://doi.org/10.1016/S1474-4422(20)30063-6.
10. Hauser SL, Bar-Or A, Comi G et al. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. N Engl J Med. 2017; 376: 221-34.
11. Montalban X, Hauser SL, Kappos L et al. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. N Engl J Med. 2017; 376: 209-20.
12. Hu Y, Turner MJ, Shields J et al. Investigation of the mechanism of action of alemtuzumab in a human CD52 transgenic mouse model. Immunology. 2009; 128: 260-70.
13. Gallo P, Centonze D, Marrosu MG. Alemtuzumab for multiple sclerosis: the new concept of immunomodulation. Multiple sclerosis and Demyelinating Disorders. 2017; 2: 7.
14. Coles AJ, Cohen JA, Fox EJ et al. Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings. Neurology. 2017; 89: 1117-26.
15. Havrdova E, Arnold DL, Cohen JA et al. Alemtuzumab CARE-MS I 5-year follow-up: Durable efficacy in the absence of continuous MS therapy. Neurology. 2017; 89: 1107-16.
16. Sigal DS, Miller HJ, Schram ED et al. Beyond hairy cell: the activity of cladribine in other hematologic malignancies. Blood. 2010; 116: 2884-96.
17. Giovannoni G, Comi G, Cook S et al. A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis. N Engl J Med. 2010; 362: 416-26.
18. Giovannoni G, Soelberg Sorensen P, Cook S et al. Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study. Mult Scler. 2018; 24: 1594-604.
19. He A, Merkel B, Brown JWL et al. Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol. 2020; 19(4): 307-16. https://doi.org/10.1016/S1474-4422(20)30067-3.
20. Kalincik T, Jokubaitis V, Spelman T et al. Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis. Mult Scler. 2018; 24(12): 1617-26. https://doi.org/10.1177/1352458517728812.