In treating patients with any neurological disease, it’s important to look at each case on an individual basis – what is helpful for one person may not be valuable in another, based on any number of variables.
With multiple sclerosis (MS), the issue of de-escalating therapies, or transitioning patients from high efficacy treatments with greater risks to approaches that may be safer but have lower efficacy, is always a question that requires careful consideration. And in older individuals, this can be a particularly worrisome issue.
We know that as patients age, there can be a concern that the high-efficacy MS medications could increase the potential for illnesses such as the John Cunningham virus (JCV) and subsequently progressive multifocal leukoencephalopathy (PML), other infections, or certain malignancies. So, knowing when to de-escalate or even discontinue a particular treatment is critical to the patient’s neurological and general wellbeing.
The John Cunningham virus, or JC virus (JCV) causes PML. JC virus is also known as human polyomavirus. 2 Most people have been infected with this virus in childhood although it rarely causes symptoms. However, people with a weakened immune system, due to either disease and/or the effects of immunosuppressant therapies are at greater risk of developing PML.1
PML is a disease of the white matter of the brain, caused by a virus infection that targets cells that make myelin, which is the material that insulates nerve cells or neurons.
A recent study regarding de-escalation.
In this study, scientists looked at the key question of de-escalation as it pertains to patient age and disease progression or instances of relapse. The authors reanalyzed data from a retrospective, real-world cohort of MS patients to model disease activity and impact of certain disease-modifying therapies (DMTs) along with patient age.
The results: “In a real-world cohort of relapsing MS patients, high efficacy DMTs had less benefit with aging but were associated with increased risks. This cohort helps overcome some limitations of trials where older patients were excluded. To better balance benefits/risks, we propose a DMT de-escalation approach for aging MS patients.”
Researchers also noted that DMTs are typically more effective early in the disease course and are therefore more justified at that stage; patient ages are also younger earlier in the disease course and there is less disability, so there is a lower risk of adverse events.
Their recommendations included considering whether de-escalating therapies as patients approach 40 to 55 years of age would be most appropriate. Patient disability, especially in those who required bilateral support or who are wheelchair bound, and DMT-specific factors that could increase infection risk should also be considered. If after de-escalation the patient is clinically stable, then discontinuing the therapy might be an option and with any proposed change in prescribed treatments, the patient and their family should always be part of the decision process.
In our practice, we approach MS and treatment for any disorder on a patient-specific basis and always review clinical status throughout any therapeutic course. It’s critical to examine the “risk vs. benefit” in making these choices and looking at all the factors that can affect disease progression. And studies like this are extremely valuable in reaffirming clinical practices for the most appropriate guidance.
If you have any questions or would like to consult with our team, please reach out to our offices – we are here to help!
In hope and healing,
Dr. Suzanne Gazda
1 Medline Plus, National Library of Medicine
2 Vollmer BL, Wolf AB, Sillau S, Corboy JR and Alvarez E (2022) Evolution of Disease Modifying Therapy Benefits and Risks: An Argument for De-escalation as a Treatment Paradigm for Patients With Multiple Sclerosis. Front. Neurol. 12:799138. doi: 10.3389/fneur.2021.799138
9/19/2022 11:49:45 pm
I never thought i could smile and be in a happy marriage again if not for the help of DR.Moses Buba. I got the doctors Emails:(firstname.lastname@example.org ) on the internet and i emailed him, and he got back to me with some encouraging words, he got me some herbs cream which i use for just 8 days and i began to feel the enlargement of my penis, and without surgery. This went on for a little period of about 10 days and to my surprise my wife keeps screaming that she love my big dick now. Now my wife no longer cheat on me, and my penis is now about 10.5 inches long on erection and off course very large round. And now my wife uses breasts, hips and bums enlargement. I and my wife are very happy for the help rendered to me by DR.Moses Buba, and i want to say a big thanks to Doctor for the help. You can contact the Doctor now on his Email:( email@example.com ) Am thankful to the doctor for helping me.
11/14/2022 05:01:03 pm
DR. OSATO`S CURE FOR HERPES1&2 - A NATURAL WAY TO GET HERPES1&2 CURED. If you have been looking for ways to naturally get rid of the herpes simplex virus from your body completely, then you are welcome to read further. Let's face reality here, you have tried so many counter drugs and you are confused, weak and angry because nothing seems to work. Good News For you my friend.... Yes, I came with good news that will liberate you from the pains and stress of herpes outbreak, you will get total cure from this virus using Dr. Osato Herbal Methodology. Who is Dr. Osato? You may ask. Dr. Osato is a herbalist and a naturalist. He researched and identified some herbs and established a unique methodology to healing the human body using Herbal medicine that was confidently entrenched in his over 30 years of experience. According to him, he has the cure for so many diseases/virus like GENITAL HERPES, HIV, DIABETES, CANCER, HPV, HSV1&2, GENITAL WART, SHINGLES, VAGINAL INFECTION and so many more. You can reach Dr Osato on his email: firstname.lastname@example.org or WhatsApp +2347051705853. You can also contact him through his website: https://osatoherbalcure.wordpress.com I am using this medium to inform everyone how to get treated of herpes using Dr Osato recommended Herbal methodology.
Leave a Reply.
Suzanne Gazda M.D.