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Natalizumab reduces loss of gray matter and thalamic volume in patients with relapsing-remitting multiple sclerosis: A post hoc analysis from the randomized, placebo-controlled AFFIRM trial - PubMed

Natalizumab reduces loss of gray matter and thalamic volume in patients with relapsing-remitting multiple sclerosis: A post hoc analysis from the randomized, placebo-controlled AFFIRM trial - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/38469809/

NCT00027300URL: https://clinicaltrials.gov/ct2/show/NCT00027300.

Natalizumab significantly reduces gray matter and thalamic atrophy in relapsing-remitting multiple sclerosis patients, with 64.3% less gray matter loss and 57.0% less thalamic volume loss compared to placebo.

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MS treatment de-escalation: review and commentary - PubMed

MS treatment de-escalation: review and commentary - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/39093335/

Almost all currently licensed disease-modifying therapies (DMTs) for MS treatment require prolonged if not lifelong administration. Yet, as people age, the immune system has increasingly reduced responsiveness, known as immunosenescence....

De-escalation of MS disease-modifying therapies in older patients may maintain efficacy while reducing risks, but larger, longer studies are needed to confirm safety and effectiveness across age groups.

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Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis - PubMed

Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/38032059/

We found mostly low and very low-certainty evidence that drugs used to treat MS may not increase SAEs, but may increase withdrawals compared with placebo. The results suggest that there...

This study compared adverse effects of multiple sclerosis immunotherapies through network meta-analyses, highlighting varying safety profiles, with low-certainty evidence for drug rankings and significant withdrawal rates due to adverse events.

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Bioavailable central nervous system disease-modifying therapies for multiple sclerosis - PubMed

Bioavailable central nervous system disease-modifying therapies for multiple sclerosis - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/38162670/

Disease-modifying therapies for relapsing multiple sclerosis reduce relapse rates by suppressing peripheral immune cells but have limited efficacy in progressive forms of the disease where cells in the central nervous...

Disease-modifying therapies for relapsing multiple sclerosis primarily target peripheral immune cells, while cladribine and sphingosine 1-phosphate receptor modulators show potential for direct effects on the central nervous system.

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Balancing Efficacy and Safety in Relapsing Multiple Sclerosis: What is Your Optimal Approach?

In the treatment of relapsing multiple sclerosis (RMS), finding the right balance between efficacy and safety remains a challenge. Advances in monotherapy options have shown significant efficacy in reducing relapse rates and slowing disease progression. However, these benefits must be weighed against potential risks, including in some cases, the heightened risk of progressive multifocal leukoencephalopathy (PML).

Recent studies emphasize the importance of patient-centered approaches when managing RMS. Tailoring treatment to individual patient profiles—including disease activity, prior treatment history, and risk factors—can optimize outcomes while mitigating risks. As the therapeutic landscape evolves, clinicians must continuously reassess the benefit-risk ratio of treatments like natalizumab to ensure the best outcomes for their patients.

How do you balance the efficacy and safety of treatment options in RMS? What factors most influence your decision-making process when choosing monotherapy for your patients?

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