Approach to Managing the Initial Presentation of Multiple Sclerosis: A Worldwide Practice Survey.

IF 2.3 Q3 CLINICAL NEUROLOGY Neurology. Clinical practice Pub Date : 2025-02-01 Epub Date: 2024-10-09 DOI:10.1212/CPJ.0000000000200376
Jodie I Roberts, Aravind Ganesh, Luca Bartolini, Tomas Kalincik
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Abstract

Background and objectives: Available disease-modifying therapies (DMTs) for multiple sclerosis (MS) are rapidly expanding; although escalation approaches aim to balance safety and efficacy, emerging evidence suggests superior outcomes for people with MS who are exposed to early high-efficacy therapies. We aimed to explore practice differences in prevailing management strategies for relapsing-remitting MS.

Methods: We used a worldwide electronic survey launched by the Practice Current section of Neurology® Clinical Practice. Questions pertained to a case of a 37-year-old woman presenting with optic neuritis. Respondents were asked to indicate their initial investigations, relapse management strategy, choice of disease-modifying therapy, and plan for follow-up imaging (contrast/noncontrast). Survey responses were stratified by key demographic variables along with 95% confidence intervals (95% CIs).

Results: We received 153 responses from 42 countries; 32.3% responders identified as MS specialists. There was a strong preference for intravenous delivery of high-dose corticosteroids (87.7%, 95% CI 80.7-92.5), and most of the responders (61.3%, 95% CI 52.6-69.4) indicated they would treat a nondisabling (mild sensory) MS relapse. When asked to select a single initial DMT, 56.6% (95% CI 47.6-65.1) selected a high-efficacy therapy (67.5% MS specialists vs 53.7% non-MS specialists). The most selected agents overall were fingolimod (14.7%), natalizumab (15.5%), and dimethyl fumarate (20.9%). Two-thirds of respondents indicated they would request contrast-enhanced surveillance MRI.

Discussion: Although there is a slight preference for initiating high-efficacy DMT at the time of initial MS diagnosis, opinions regarding the most appropriate treatment paradigm remain divided.

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处理多发性硬化症初期症状的方法:全球实践调查。
背景和目的:多发性硬化症(MS)可用的改变病情疗法(DMT)正在迅速增加;尽管升级方法旨在平衡安全性和有效性,但新出现的证据表明,接受早期高效疗法的多发性硬化症患者疗效更佳。我们旨在探索复发性缓解型多发性硬化症现行管理策略的实践差异:我们使用了《神经病学®临床实践》"Practice Current "栏目发起的全球电子调查。问题涉及一名患有视神经炎的 37 岁女性病例。调查要求受访者说明他们的初步检查、复发处理策略、疾病调整疗法的选择以及后续成像(对比/非对比)计划。调查结果:我们收到了来自 42 个国家/地区的 153 份回复:我们收到了来自 42 个国家的 153 份回复;32.3% 的回复者自称是多发性硬化症专家。答复者强烈倾向于静脉注射大剂量皮质类固醇(87.7%,95% CI 80.7-92.5),大多数答复者(61.3%,95% CI 52.6-69.4)表示他们将治疗非致残性(轻度感觉性)多发性硬化症复发。当被要求选择单一初始 DMT 时,56.6%(95% CI 47.6-65.1)的患者选择了高效疗法(67.5% 的多发性硬化症专家与 53.7% 的非多发性硬化症专家)。选择最多的药物是芬戈莫德(14.7%)、纳他珠单抗(15.5%)和富马酸二甲酯(20.9%)。三分之二的受访者表示他们会要求进行造影剂增强磁共振成像监测:讨论:尽管受访者略微倾向于在初次诊断多发性硬化症时启动高效 DMT,但对于最合适的治疗模式仍存在意见分歧。
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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
期刊最新文献
A Systematic Review of Sleep Disturbance in Idiopathic Intracranial Hypertension. Advancing Patient Education in Idiopathic Intracranial Hypertension: The Promise of Large Language Models. Anti-Myelin-Associated Glycoprotein Neuropathy: Recent Developments. Approach to Managing the Initial Presentation of Multiple Sclerosis: A Worldwide Practice Survey. Association Between LACE+ Index Risk Category and 90-Day Mortality After Stroke.
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