Abstract
When intensive treatment is initiated before the inflammation behind the blood-brain barrier is closed, the potential to affect multiple sclerosis is the greatest. Thus, early initiation of high efficacy therapy appears to be the best therapeutic strategy for most patients, and thanks to the change in reimbursement criteria, this strategy can be chosen in the Czech Republic too.
However, in a minority of patients with mild forms of the disease, there is no reason to take a safety risk and the appropriate choice is an escalation strategy. The choice can be made based on prognostic markers, but these are not perfect and the price for insufficiently intensive treatment is irreversible damage to nerve structures.
Therefore, monitoring and re-evaluation of the strategy regarding its effectiveness and adverse effects is the key.