Meca-Lallana J E, Martínez Yélamos S, Eichau S, Llaneza M Á, Martín Martínez J, Peña Martínez J, Meca Lallana V, Alonso Torres A M, Moral Torres E, Río J, Calles C, Ares Luque A, Ramió-Torrentà L, Marzo Sola M E, Prieto J M, Martínez Ginés M L, Arroyo R, Otano Martínez M Á, Brieva Ruiz L, Gómez Gutiérrez M, Rodríguez-Antigüedad Zarranz A, Sánchez-Seco V G, Costa-Frossard L, Hernández Pérez M Á, Landete Pascual L, González Platas M, Oreja-Guevara C
Unidad de Neuroinmunología Clínica y CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio (UCAM), Murcia, Spain.
Unidad de Esclerosis Múltiple «EMxarxa», Servicio de Neurología. H.U. de Bellvitge, IDIBELL, Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain.
Neurologia (Engl Ed). 2024 Mar;39(2):196-208. doi: 10.1016/j.nrleng.2024.01.003. Epub 2024 Jan 16.
The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.
西班牙神经病学学会脱髓鞘疾病研究组关于多发性硬化症（MS）治疗的上一份共识声明发布于2016年。尽管所采取的许多立场仍然有效，但MS的管理和治疗已发生了重大变化，这既是由于批准了具有不同作用机制的新药，也是由于先前固定概念的演变。这使得针对特定情况（如妊娠和疫苗接种）有了新的方法，并在临床决策中纳入了新的变量，如早期使用高效疾病修正疗法（DMT）、考虑患者的观点以及使用远程监测等新技术。鉴于这些变化，这份根据德尔菲法制定的更新后的共识声明旨在基于现有科学证据和参与者的临床专业知识，反映MS患者管理的新范式。最重要的建议是，对于有持续放射学活动的放射学孤立综合征患者应开始免疫调节性DMT治疗，应考虑患者的观点，并且在DMT分类中不再使用“治疗线”一词（>90%的共识）。MS诊断后，应根据出现新复发或残疾进展的预后不良因素（无论是流行病学、临床、放射学还是生物标志物）的有无来选择首个DMT；从疾病发作起就可考虑使用高效DMT。
