1Division of Neurology,Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute,Ottawa,ON,Canada.
4St. Michael's Hospital,University of Toronto,Toronto,ON,Canada.
Can J Neurol Sci. 2018 Sep;45(5):489-503. doi: 10.1017/cjn.2018.17. Epub 2018 Jun 12.
Recent therapeutic advances in the management of multiple sclerosis (MS) have raised questions about the selection of appropriate patient candidates for various treatments and, if the plan is to move from one treatment to another, the appropriate sequencing of these therapies. The selected approach should provide optimal disease management without limiting future therapeutic options based on safety concerns, and recognize potential future treatments and the possibility of combination therapies. Additional challenges include incorporation of patient needs and preferences into the overall therapeutic approach, in order to ensure optimal outcomes in the short and long term. The objective of this manuscript is to provide an overview of what is currently known regarding the impact of various therapies for MS on future therapeutic choices (sequencing). In this context, we reviewed the available evidence in support of various treatments and, based on the presence of disease activity, suggested a scheme for switching or escalating therapy with the main focus on sequencing of therapeutic approaches.
近年来，多发性硬化症（MS）的治疗进展提出了有关选择各种治疗方法的合适患者候选人的问题，如果计划从一种治疗方法转为另一种治疗方法，则需要对这些治疗方法进行适当的排序。选择的方法应该提供最佳的疾病管理，而不会因安全性问题而限制未来的治疗选择，并认识到潜在的未来治疗方法和联合治疗的可能性。其他挑战包括将患者的需求和偏好纳入整体治疗方法中，以确保在短期和长期内获得最佳结果。本文的目的是概述目前已知的各种 MS 治疗方法对未来治疗选择（排序）的影响。在这种情况下，我们回顾了支持各种治疗方法的现有证据，并根据疾病活动的存在，提出了一种切换或升级治疗的方案，主要关注治疗方法的排序。
