Multiple sclerosis and related disorders
-
Mult Scler Relat Disord · Jul 2016
ReviewVariations in multiple sclerosis practice within Europe - Is it time for a new treatment guideline?
In the past 5 years, the combination of developments in diagnostic strategy and approval of new disease-modifying therapies has provided an opportunity to achieve dramatic improvements in patient outcomes in multiple sclerosis (MS). However, across Europe there are several factors that may prevent patients from receiving the best therapy at the appropriate time, and there is variation among countries in terms of which of these factors are most relevant. ⋯ While recognizing that policy is not static in any country, we believe that patients' interests would be better served if a European treatment guideline was developed. Such a guideline could both inform and be informed by national policies, facilitating the dissemination of best clinical practice internationally.
-
Mult Scler Relat Disord · Jul 2016
ReviewRe-evaluating the incidence of natalizumab-associated progressive multifocal leukoencephalopathy.
To estimate the prospective risk of developing PML during therapy with natalizumab in JCV-seropositive patients. ⋯ Biogen's statistics concerning the risk of PML on natalizumab, while in principle helpful, underestimate the true incidence systematically and significantly; realistic estimates of the longterm risk of PML are nearly double those previously published, with some patient groups carrying a risk that is almost nine times higher. Fortunately, a refined risk-stratification algorithm with the incorporation of such markers as L-selectin and CSF lipid-specific IgM bands has the potential to make natalizumab a considerably safer drug.