More important changes for multiple sclerosis patients

Huge advances in multiple sclerosis therapy have been underway for more than 20 years. Newer and newer immunomodulatory therapies with high efficacy are entering the market, which are positively changing the course of this disease. According to current knowledge of the pathomechanism of multiple sclerosis, it is very important to start effective treatment as early as possible, before the patient develops irreversible changes in the central nervous system. In Poland, however, access to modern therapies was severely limited for many years. Thanks to the concerted efforts of the clinician community, patient organizations and policymakers, the situation has improved very significantly in recent months. In November 2022, major changes were made to the drug program for the treatment of MS, which enabled proper, modern therapy in line with international expert recommendations.

- In recent years, the treatment paradigm for MS has changed. There is an increasingly common model of therapy around the world that relies on the use of highly effective drugs from the very beginning, that is, right after the disease is diagnosed. In multiple sclerosis, we are dealing with two processes: the inflammatory process, which is strongest at the beginning of the disease, and the neurodegenerative process, which intensifies with the duration of the disease. The drugs that are currently registered for the treatment of multiple sclerosis have an inhibitory effect mainly on the inflammatory process, and therefore we should do our best to start effective treatment precisely when the inflammatory process is dominant and the patient is in good neurological condition. The nervous system does not regenerate or regenerates only to a small degree, so if damage to the nervous system and neurological symptoms occur, these will most often be irreversible changes. On the other hand, inhibition of the disease at the very beginning of its course prevents the onset of disability, which, of course, translates into quality of life for patients, who can function completely normally, realize family and social life and work professionally. Although the drug program in effect since November is a milestone for MS patients in accessing highly effective therapies, it can always be better. That's why we welcomed the draft of the new reimbursement list and the introduction of two more highly effective drugs to the program, already in the first line of treatment. For there are patients in whom - for various reasons - we would like to reach for either of these drugs from the beginning of treatment, and now it will be possible," says Prof. Monika Adamczyk-Sowa, MD, president of the Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society.

Ocrelizumab is a humanized monoclonal antibody directed against the CD20 antigen, which is found on B lymphocytes. As many years of clinical trials have shown, this drug is very effective in the treatment of both the projection-remission form of MS and the primary progressive form of multiple sclerosis. Patients with the projection-remission form of MS receiving treatment with okrelizumab had a very significant decrease in the number of relapses and inhibition of disability progression (the risk of developing disability assessed at 6 points on the EDSS scale was reduced), and more than one-third of patients even showed improvement in the EDSS scale. The drug also has a very pronounced effect for inhibiting atrophy, i.e. atrophy of brain tissue, and preserving cognitive function. The safety profile of okrelizumab is well understood, and it is a favorable one.

- We are extremely pleased with another good decision by the Ministry of Health, which has decided to further expand access to highly effective drugs that can be used in the 1st line of MS treatment. As a result, Polish patients will gain access to a wide range of immunomodulatory drugs registered for the treatment of multiple sclerosis in the projection-remission form, according to their registration records. This provides the opportunity to personalize therapy, which is something we are very keen on, since MS is an extremely individualized disease; no two people have exactly the same course of the disease. Thanks to the current wide availability of drugs
in Poland, therapy can be individually, precisely tailored to the patient, taking into account the activity of the disease and the patient's preferences and lifestyle. For professionally active people with MS, it is important that the treatment used is as light as possible and does not involve frequent absences from work and many visits to the clinic or hospital, comments Tomasz Połeć, president of the Polish Multiple Sclerosis Society.

- People with MS are usually young, professionally active people with various life plans, and the treatment undertaken should not interfere with these intentions and ambitions. Therefore, the choice of therapy should be a joint decision between doctor and patient. The wider the range of available therapies, the greater the choices, which is, of course, for the benefit of patients and their well-being. We are grateful to the Ministry of Health for understanding our needs and for expanding the palette of first-line therapeutic options to include okrelizumab and cladribine, " says Malina Wieczorek, president of the MS Foundation - Fight for Yourself.

Source: press mat.