Abstract
We have disease modifying drugs (DMDs – interferon beta, glatiramer acetate) for the treatement of multiple sclerosis (MS) for 15 years in Czech Republic. Only 30 % of patients are full responders to this treatment, in the rest the effect is insufficient or partial.The only possibility for treatment escalation until 2008 was mitoxantrone (with only transient effect and serious adverse events).
Since 2008 we can use the first monoclonal antibody in neurology, natalizumab, with doubled clinical efficacy in comparison with classical DMDs. Natalizumab has brought the concept of „freedom of disease activity“.
New drugs which are currently in registration process (fingolimod) or finished their phase III program (cladribine, teriflunomide, laquinimod, fumarate) will offer higher efficacy or convenience for patients but will demand more knowledge about their mechanism of action and risks, their prevention, diagnosis and management. The same is true for new monoclonal antibodies (alemtuzumab, anti-CD 20, daclizumab).
Informed consent and evaluation of compliance will be part of the treatment of well-educated patients. The main concern being the early diagnosis using the new criteria and early treatment. will be the most important factors changing the prognosis of MS patients.