Dr Scheiderbauer’s comment picks up the important topic of balancing risks and benefits in the treatment of multiple sclerosis (MS). The main question is whether the current diagnostic and therapeutic recommendations may in individual cases result in unnecessary overtreatment of MS patients. Therapeutic algorithms are as a rule based on insights gained from randomized controlled studies. Applying results from study cohorts to the situation in routine clinical practice is not always straightforward, however. Observational studies can partly close this gap (1). In our review article, we intentionally placed the main focus on interdisciplinary risk management after a therapeutic decision had been made (2). Topics that lead further, such as therapeutic algorithms, integrated treatment approaches, and evaluation of the NEDA (“no evidence of disease activity”) criteria were not the subject of our article.
The importance of networks for capturing the risks but also for improved prognostic classification and more targeted indications for MS therapies is undisputed. Worldwide, several initiatives exist in this setting. In order to bring together the various research efforts in Germany, the disease-specific competence network multiple sclerosis (KKNMS) has received funding from the Federal Ministry of Education and Research since 2009. The focus of this nationwide research alliance is on the long-term improvement of the diagnostic, therapeutic, and care quality of patients with MS.
On behalf of the authors
Dr. med. Joachim Havla
Institut für Klinische Neuroimmunologie
Biomedizinisches Zentrum und Klinikum der Ludwig-Maximilians Universität, München
Conflict of interest statement
Dr. Havla has received consultancy fees from Novartis, Genzyme, and Biogen. He has received reimbursements of congress attendance and travel costs from Novartis, Biogen, Merck Serono, and Genzyme. He has received speaker honoraria from Novartis.
|1.||Trojano M, Tintore M, Montalban X, et al.: Treatment decisions in multiple sclerosis—insights from real-world observational studies. Nat Rev Neurol 2017; 13: 105–18 CrossRef MEDLINE|
|2.||Havla J, Warnke C, Derfuss T, Kappos L, Hartung HP, Hohlfeld R: Interdisciplinary risk management in the treatment of multiple sclerosis. Dtsch Arztebl Int 2016; 113: 879–86 VOLLTEXT|