Multiple Sclerosis Decision Model (MSDM): Entwicklung eines Mehrfaktorenmodells zur Beurteilung des Therapie- und Krankheitsverlaufs bei schubförmiger Multipler Sklerose

Zusammenfassung

Die Einführung neuer und potenter Therapeutika für die Behandlung der schubförmigen Multiplen Sklerose (MS) hat die Ansprüche an den Therapieerfolg gesteigert. Eine alleinige Reduktion der Schubrate ist nicht mehr ausreichend, sondern das Ziel sollte eine „Freiheit von klinisch relevanter Krankheitsaktivität“ sein. Eine allgemein akzeptierte Definition liegt derzeit noch nicht vor. Ein deutsches Expertengremium formulierte hierzu die Forderung, dass ein solcher Parameter neben der Schubrate, Behinderungsprogression und MRT-Parametern auch neuropsychologische Kriterien und Lebensqualität eingeschlossen werden sollten. Wie dies unter Alltagsbedingungen gemessen werden kann, bedarf einer weiteren Präzisierung. Um die Untersuchungen standardisiert, zeitökonomisch und schematisiert durchzuführen, wird hier ein Mehrfaktorenmodell (Multiple Sclerosis Decision Model, MSDM) vorgeschlagen, welches die Domänen „Schub“, „Behinderungsprogression“, „MRT“ und „Neuropsychologie“ beinhaltet. Die vorgeschlagenen Tests bilden die Komplexität der Erkrankung auch in frühen Stadien ab, in denen eine Progression mit z. B. der EDSS (Expanded Disability Status Scale) nur schwer zu erfassen ist. Das MSDM soll eine Hilfe für Therapieentscheidungen darstellen und ein Therapieversagen frühzeitig anzeigen. Prospektive Untersuchungen sind erforderlich, um zu prüfen, ob mittels dieses Instruments zum Krankheitsmonitoring tatsächlich eine effektivere Behandlung und schnellere Krankheitsstabilisierung erreicht werden kann.

Abstract

The introduction of new and potent medications for the treatment of relapsing-remitting multiple sclerosis (MS) has increased the desire for therapeutic success. The mere reduction of the relapse rate is not sufficient anymore. Instead, the goal should be the “absence of clinically relevant disease activity”. However, there is no generally accepted definition so far. A panel of German experts has proposed that achievement of this therapeutic aim should include – beside relapse rate, disability progression and MRI parameters – neuropsychological tests and quality of life measures. A specification is required as to how this can be measured in everyday practice. In order to standardise the investigations in an economic and schematic way, a multifactorial model (Multiple Sclerosis Decision Model, MSDM) is proposed that includes the domains “relapse”, “disability progression”, “MRI”, and “neuropsychology”. The proposed tests reflect the complexity of the disease even in the early stages when scales like the EDSS (Expanded Disability Status Scale) are not able to discriminate low levels of progression. The MSDM is intended to support early treatment decisions and uncover treatment failures early on. Prospective investigations are required to prove that such a disease monitoring does indeed lead to an early and effective disease stabilisation.

Schlüsselwörter

Multiple Sklerose - Therapie - Therapiemanagement

Keywords

multiple sclerosis - treatment - management of treatment

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