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Therapeutic Strategies and Disease-Modifying Therapies for Multiple Sclerosis Haruhiko Motegi 1,2 , Satoshi Kitagawa 1 , Jin Nakahara 1 1Department of Neurology, Keio University School of Medicine 2Department of Neurology, The Jikei University School of Medicine Keyword: 多発性硬化症 , 治療戦略 , 疾患修飾薬 , 個別化治療 , 早期強化治療 , multiple sclerosis , disease-modifying therapy , personalized approach , high-efficacy therapy , early top-down strategy pp.485-490
Published Date 2023/5/1
DOI https://doi.org/10.11477/mf.1416202363
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Abstract

Multiple sclerosis is an inflammatory demyelinating disease of unknown cause that affects the central nervous system. Although it was once deemed “incurable,” many disease-modifying therapies have been introduced since the beginning of the 20th century; eight of these are now available in Japan. Treatment for multiple sclerosis is undergoing a significant shift from the safety-oriented “escalation strategy,” in which the patient is initially administered medications with low risks of side effects but moderate efficacy, to a “personalized approach” based on individual prognostic factors followed by an “early top-down strategy” in which higher efficacy treatments are initiated first. Disease-modifying drugs for multiple sclerosis can be high- (fingolimod, ofatumumab, natalizumab) or moderate-efficacy (interferon beta, glatiramer acetate, dimethyl fumarate), and there are also disease-modifying therapies for secondary progressive multiple sclerosis (siponimod and ofatumumab). Approximately 20,000 Japanese patients have multiple sclerosis, and this number continues to increase. Many neurologists are expected to prescribe high-efficacy drugs in the future. The risk management of adverse events, particularly progressive multifocal leukoencephalopathy, is required to ensure that the importance of safety never be underestimated, even though treatment efficacy is the main focus.


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電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院

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