Therapieziele und Therapiemanagement bei schubförmigremittierender Multipler Sklerose

Zusammenfassung

Unsere Expertengruppe hatte im Jahr 2012 Therapieziele der immunmodulatorischen Behandlung der schubförmig-remittierenden MS (RRMS) formuliert: Übergeordnetes Therapieziel ist die bestmögliche Krankheitskontrolle, messbar an der Freiheit von klinisch und kernspintomografisch nachweisbarer Krankheitsaktivität. Die Therapie sollte daher früh mit einem möglichst wirksamen Medikament begonnen und bei unzureichender Effektivität rechtzeitig optimiert werden. Dementsprechend sind individuell optimierte Therapieentscheidungen auf der Basis der sensitiven Detektion von Krankheitsaktivität essenziell. In einem zweiten Workshop 2014 erörterte die Expertengruppe Kriterien und Prozeduren für das Monitoring und Management von RRMSPatienten. Schubereignisse sind durch sorgfältige Anamnese bei regelmäßigen neurologischen Untersuchungen zu erfassen. Veränderungen des Behinderungsstatus sollten mit gut quantifizierbaren Parametern mindestens einmal jährlich, besser halbjährlich erhoben werden. Dabei sind relevante funktionelle Systeme, Kognition, Fatigue und Depression einzubeziehen. MRT-Befunde sind zunehmend als frühe Indikatoren für unzureichende Therapiewirkung relevant. Voraussetzung sind technisch konsistente, standardisierte MRT-Aufnahmen. Derzeit steht die Detektion neuer und vergrößerter Läsionen im Vordergrund. Die Hirnatrophie als zusätzlicher Parameter ist unter Routinebedingungen noch nicht verlässlich messbar. Patientenzentrierte Faktoren wie individuelle Lebensqualität, persönliche Ziele und spezifische Lebensführung sollten in Verlaufsbeobachtung und Therapieentscheidung maßgeblich einfließen. Standardisierte Patientenmanagementsysteme können die Konsistenz und Qualität der langfristigen Betreuung verbessern. Auch von intersektoral-interdisziplinären Netzwerken mit MS-Zentren als Schaltstellen ist eine Verbesserung der Versorgungsqualität zu erwarten.

Summary

In 2012, our expert group formulated treatment goals for the immunomodulatory therapy of relapsing-remitting MS (RRMS): the primary aim is the best achievable control of disease activity, as measured by the absence of clinical and MRI-detectable disease activity. Treatment of RRMS should therefore be initiated early with an effective medication. Prompt adaptation is required in the case of insufficient disease suppression. Accordingly, the sensitive clinical and MRI-based detection of disease activity is essential for individually optimized treatment decisions. In a second workshop in 2014, the expert group discussed criteria and procedures for the monitoring and management of RRMS patients. Relapse episodes should be detected by carefully taking patient history at regular neurologic visits. Changes in the disability status should be monitored clinically and supplemented by sensitive quantitative tools at least annually, or better in 6 months intervals. Monitoring should cover relevant functional systems, neurocognition, fatigue, and depression. MRI becomes increasingly important in providing early evidence of disease activity. It remains currently focused on the detection of new or enlarging lesions. Global brain atrophy cannot be reliably quantified in routine care to date. Patient- reported outcomes such as quality of life, personal goals and factors affecting life-style requirements should be represented in monitoring and treatment decisions. Standardized patient management systems can improve the consistency and benefit of long-term care. Cooperation in multi-sector and interdisciplinary networks with MS centers working as the hubs will also likely contribute to the quality of care.

Schlüsselwörter

Schubförmig-remittierende Multiple Sklerose - immunmodulatorische Therapie - Krankheitsaktivität - Therapieziele

Keywords

Relapsing remitting multiple sclerosis - immunomodulatory therapy - disease activity - treatment goals

^* Mitglieder des Expertengremiums: A. Gass, R. Gold, J. Haas, L. Harms, M. Haupts, H. Honig, B. Kallmann, C. Klawe, C. Kleinschnitz, M. Lang, R. Linker, C. Lukas, M. Marziniak, M. Mäurer, I. Penner, S. Rauer, P. Rieckmann, S. Schippling, S. Schmidt, H. Silberg, M. Stangel, B. Tackenberg, F. Weber, B. T. Wildemann, J. Würfel, U. Zettl, T. Ziemssen

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