2018 Volume 35 Issue 2 Pages 79-82
European Committee for Treatment and Research in Multiple Sclerosis, the world–largest MS meeting, held in Paris in 2017 attracted more than 10,000 participants. This is mainly because a number of modifying drugs (DMD) for MS have been developed and approved in the last two decades. Interferon ß, an injectable, was the first approved DMD for MS. Thereafter, more potent DMD and oral DMD have been developed, and as of June, 2018, 6 DMD are now available in Japan while 15 DMD have been approved in Europe and North America. With multiple therapeutic options, we need to optimize MS therapy in view of various factors. Early diagnosis and treatment are imperative for improving the prognosis of MS. McDonald criteria have been revised for the diagnosis of MS, and several revisions for making earlier diagnosis were made in the 2017 version, but careful diagnostic workup to exclude alternative diagnoses is critically important. Neuromyelitis optica has been widely recognized after the discovery of aquaporin–4 antibody and should not be misdiagnosed with MS. Although escalation therapy has been a usual strategy for MS, adopting induction therapy and achieving “No Evidence of Disease Activity” are now seriously considered for better long–term outcomes. Challenges to be addressed in Japan include, 1) “Drug lag”. Pharmaceutical and Medical Devices Agency recommends participating in international clinical trials to resolve it. 2) MS–DMD–associated progressive multifocal leukoencephalopathy worries neurologists and calls for clinical vigilance. 3) Only patients with moderate or severe disabilities or those who have a mild disease but need high cost medical care are registered under the new law of “intractable diseases” including MS and NMO.
