Aggressive multiple sclerosis (2): Treatment
Georgina Arrambide, Ellen Iacobaeus, Maria Pia Amato, Tobias Derfuss, Sandra Vukusic, Bernhard Hemmer, Lou Brundin, Mar Tintoré, for the 2018 ECTRIMS Focused Workshop Group, Joseph R. Berger, Alexey Boyко, Vesna Brinar, Wallace Brownlee, Olga Ciccarelli, Alasdair Coles, Jorge Correale, Gary Cutter, Gilles Edan, Nikolaos Evangelou, Óscar Vallina Fernández, Jette Lautrup Frederiksen, Ralf Gold, Yael Hacohen, Hans‐Peter Hartung, Kerstin Hellwig, Jan Hillert, Jaime Imitola, Tomáš Kalinčík, Ludwig Kappos, Samia J. Khoury, Ho-Jin Kim, Eva Havrdová, Roland Liblau, Jan Lycke, Xavier Montalbán, Paolo A. Muraro, Stephen C. Reingold, Klaus Schmierer, Finn Sellebjerg, Per Soelberg Sørensen, Alessandra Solari, Maria Pia Sormani, Alan J. Thompson, Bruce D. Trapp, Helen Tremlett, María Trojano, Carmen Tur, Antonio Uccelli, Vincent Van Pesch, Emmanuelle Waubant
Abstract
The natural history of multiple sclerosis (MS) is highly heterogeneous. A subgroup of patients has what might be termed aggressive MS. These patients may have frequent, severe relapses with incomplete recovery and are at risk of developing greater and permanent disability at the earlier stages of the disease. Their therapeutic window of opportunity may be narrow, and while it is generally considered that they will benefit from starting early with a highly efficacious treatment, a unified definition of aggressive MS does not exist and data on its treatment are largely lacking. Based on discussions at an international focused workshop sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), we review our current knowledge about treatment of individuals with aggressive MS. We analyse the available evidence, identify gaps in knowledge and suggest future research needed to fill those gaps. A companion paper details the difficulties in developing a consensus about what defines aggressive MS.