Immunosuppression in relapsing remitting multiple sclerosis: moving towards personalized treatment

ABSTRACT

Introduction

Therapeutic armamentarium in Multiple Sclerosis (MS) has radically changed in the last few decades due to the development of disease modifying treatments (DMTs) with highly selective mechanisms of action.

Areas covered

In this review, the authors will focus on the current role of immunosuppressive DMTs in the management of the relapsing-remitting form of MS (RRMS), moving from the rationale of its use and looking at the possibility to design an idealistic scenario of a personalized approach for each single patient.

Expert opinion

Questions remain open about whether initial high-efficacy immunosuppressive DMTs improve long-term outcomes, whether prolonged exposure to these agents increases adverse events and what the strongest early surrogate markers are for predicting long-term treatment responses to high-efficacy drugs. In this way, the immunosuppressive DMTs, are used to hit the immune system early and hard with the idealistic goal of striking the autoimmune activities before the neurological damage becomes irreversible.

KEYWORDS:

• Immunosuppression
• personalized therapy
• multiple sclerosis
• induction
• therapeutic approach

Article highlights

• A challenge encountered by Multiple Sclerosis specialists is represented by the therapeutic management of patients with aggressive forms of Multiple Sclerosis or of patients who are intolerant, non-responsive to approved disease modifying treatments.

• Inflammation is the unique target of our available immune therapy and any realistic therapeutic strategy should be based on impacting the neuroinflammation with a range of possibilities.

• Questions remain open about whether initial high-efficacy disease modifying treatments improve long-term outcomes, whether prolonged exposure to these agents increases adverse events and what the strongest early surrogate markers are for predicting long-term treatment responses to high-efficacy drugs.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.