Gasperini Claudio, Centonze Diego, Conte Antonella, Gallo Paolo, Lugaresi Alessandra, Patti Francesco, Trojano Maria, Amato Maria Pia, Filippi Massimo
Department of Neurosciences, S Camillo Forlanini Hospital, Rome, Italy.
Department of Systems Medicine, Tor Vergata University, Rome, Italy.
J Neurol. 2025 May 27;272(6):428. doi: 10.1007/s00415-025-13173-2.
The increasing availability of disease-modifying therapies (DMTs) may provide more personalized treatment options for multiple sclerosis (MS) based on various factors, including patients' characteristics, prognostic indicators, comorbidities, and safety. In Italy, recent efforts focused on promoting interdisciplinary, patient-centered care and equitable access to optimized therapies, as reported in the 2023 Barometer of Multiple Sclerosis and Related Diseases from the Italian Multiple Sclerosis Association. A key challenge is ensuring equitable access to homogeneous and personalized therapeutic strategies.
Using a Delphi methodology, a panel of Italian neurologists with expertise in MS evaluated consensus on specific aspects of MS treatments, including personalized therapy, patient involvement in decision-making, treatment flexibility, self-management of therapies, perception of treatment efficacy and safety and therapeutic sequence management.
Of 166 votes, 116 statements reached consensus (68% positive, 2% negative), representing 70% of the total, whereas 50 (30%) highlighted areas of non-consensus. The findings emphasize the central role of neurologists, the importance of personalized therapy, the inclusion of patients in therapeutic choices to enhance adherence and quality of life, and managing both quality of life and caregiver burden. Most high-efficacy disease-modifying therapies (HE DMTs), like cladribine and anti-CD20 therapies, recognized for their efficacy and convenience of administration, received positive consensus, emphasizing their perceived value in individualized treatment approaches.
This research highlights best practices and provides a roadmap for improving patient outcomes through tailored, well-communicated therapeutic strategies.
随着疾病修正治疗（DMTs）的可及性不断提高，可能会基于多种因素为多发性硬化症（MS）提供更个性化的治疗选择，这些因素包括患者特征、预后指标、合并症和安全性。在意大利，如意大利多发性硬化症协会2023年多发性硬化症及相关疾病晴雨表所报告的，近期的工作重点是促进跨学科、以患者为中心的护理以及公平获得优化治疗。一个关键挑战是确保公平获得同质化和个性化的治疗策略。
采用德尔菲法，由一组在MS方面具有专业知识的意大利神经科医生对MS治疗的特定方面达成共识，包括个性化治疗、患者参与决策、治疗灵活性、治疗自我管理、对治疗疗效和安全性的认知以及治疗顺序管理。
在166票中，116项陈述达成共识（68%为肯定，2%为否定），占总数的70%，而50项（30%）突出了未达成共识的领域。研究结果强调了神经科医生的核心作用、个性化治疗的重要性、让患者参与治疗选择以提高依从性和生活质量，以及管理生活质量和照顾者负担。大多数高效疾病修正治疗（HE DMTs），如克拉屈滨和抗CD20治疗，因其疗效和给药便利性而得到认可，获得了积极共识，强调了它们在个体化治疗方法中的感知价值。
本研究突出了最佳实践，并为通过量身定制、沟通良好的治疗策略改善患者预后提供了路线图。
