The treatment of multiple sclerosis (MS) has undergone significant changes since the first disease-modifying therapy (DMT) drug was introduced. Currently, 19 original DMT drugs are registered in the European Union. The choice of optimal therapy is becoming increasingly challenging in the absence of reliable biomarkers on the basis of which disease progression and prognosis can be determined. In addition, longer availability and a growing number of drugs used in MS mean that doctors and patients may have to change therapy when the treatment is ineffective or is associated with the occurrence of adverse effects. The ageing of the MS population, comorbidities, and administration of other drugs during DMT should also be considered. This paper presents recommendations for initiating, monitoring, changing and possibly discontinuing DMT.
Keywords: clinically isolated syndrome; disease-modifying therapy; multiple sclerosis; primary progressive multiple sclerosis; radiologically isolated syndrome; recommendations; relapsing-remitting multiple sclerosis; secondary progressive multiple sclerosis.