多発性硬化症治療開始前と治療中の注意点

抄録

Currently, the treatment of multiple sclerosis (MS) is divided into acute phase and relapse/progression prevention treatment.

Conventional escalation therapy for relapse prevention in relapsing–remitting MS (RRMS) in Japan has been the use of injectable interferon beta 1a, 1b and glatiramer acetate as first–line treatment, oral dimethyl fumarate (speaker's personal opinion), then second–line fingolimod hydrochloride and finally natalizumab and ofatumumab as third–line agents have been used. However, overseas data have shown that early diagnosis and treatment can improve ADL and QOL in MS patients over the long term, and early high–efficacy therapy (HET), in which third–line drugs are used from early diagnosis, is becoming the global trend in relapsing–remitting therapy. In this context, the drug lag for newly approved MS drugs in Japan has been shortened through global clinical trials, and siponimod for secondary progressive MS (SPMS) and ofatumumab for SPMS with active disease have become the drugs of choice.

On the other hand, the mechanism of action of each drug for RRMS and SPMS is different, and the use of each drug should be determined by considering age, gender and number of risks. The number of patients with MS in Japan is about 1/10 of those in Europe and the USA, and it is not a common disease. Even neurologists with less than 10 outpatient cases of MS and little experience in treating patients with MS are often hesitant to make decisions on initial diagnosis, selection of acute phase, post–treatment and relapse prevention, decision–making on progressive transition, drug selection and modification including vaccination and pregnancy, and informed consent to the patient.

The 2023 MS/NMOSD guideline therefore presents a drug selection algorithm for relapse/progression prophylaxis treatment, unlike the previous edition. Patient with MS was quite theoretically armed with information from the internet, in some cases due to information overload in many young patients with MS. In order to respond to the questions posed by such patients in the outpatient setting, it is necessary to collect the correct information to be able to respond to them. In this article, we use the experience and knowledge we have gained from web lectures, You tube videos and booklets produced in collaboration with the Neuroimmunology Outpatient Department of a university hospital and patient groups such as the MS cabin, and from correspondence with MS experts at home and abroad, to provide information on information gathering before treatment initiation, what to remember during treatment, complications and side–effects, and what to expect during treatment. The lecture will also cover complications and side effects, precautions during pregnancy and breast–feeding, and the fact that inertia is not just about changing drugs, but also about when to discontinue drugs in the elderly.