Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Neurol. 2022 Mar;269(3):1670-1677. doi: 10.1007/s00415-021-10836-8. Epub 2021 Oct 9.
Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit-risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.
早期采用高效疾病修正治疗（HE DMT）可能是延迟多发性硬化症（MS）不可逆神经损伤和疾病进展的最佳策略。然而，在欧洲医疗保健系统中，尽管监管标签更广泛，但由于报销限制，患者获得 MS 中的 HE DMT 往往仅限于疾病的后期阶段。尽管并非每个患者都应在疾病的初始阶段接受 HE DMT 治疗，但早期和不受限制地获得具有积极获益风险特征和合理价值主张的 HE DMT 将为基于专家医生和患者之间的共同决策的适当治疗提供选择自由。这将进一步优化结果，并促进医疗保健系统和社会中的资源分配效率和可持续性。
