Andrés Barboza , Jorge Correale , Ricardo Alonso , Marcos Burgos , Fernando Cáceres , Edgar Carnero-Contentti , Adriana Carrá , Edgardo Cristiano , Marcela Fiol , Orlando Garcea , Geraldine Luetic , Liliana Patrucco , Raúl Piedrabuena , Juan I. Rojas , Berenice Silva , Vladimiro Sinay , Carlos Vrech , María Célica Ysrraelit
{"title":"Estrategias en el uso de terapias de alta eficacia en esclerosis múltiple: ¿qué cambió en los últimos años?","authors":"Andrés Barboza , Jorge Correale , Ricardo Alonso , Marcos Burgos , Fernando Cáceres , Edgar Carnero-Contentti , Adriana Carrá , Edgardo Cristiano , Marcela Fiol , Orlando Garcea , Geraldine Luetic , Liliana Patrucco , Raúl Piedrabuena , Juan I. Rojas , Berenice Silva , Vladimiro Sinay , Carlos Vrech , María Célica Ysrraelit","doi":"10.1016/j.neuarg.2025.04.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The management of multiple sclerosis (MS) has evolved significantly with the availability of high-efficacy therapies (HETs). In 2023, Argentine neurologists evaluated treatment strategies, and given new real-world evidence and healthcare system changes, utilization patterns were reanalyzed.</div></div><div><h3>Objective</h3><div>To assess changes in HET utilization over two years and provide recommendations for different clinical scenarios (disease activity, progression, and adverse events).</div></div><div><h3>Methods</h3><div>The same 18 specialists from the initial 2023 study were re-surveyed using the original questionnaire. Previous responses were compared, with consensus defined as ≥<!--> <!-->60% agreement. Therapies were evaluated based on efficacy and safety, excluding cost considerations.</div></div><div><h3>Results</h3><div>Unanimous consensus classified alemtuzumab, natalizumab, ocrelizumab, ofatumumab, and cladribine as HETs, while excluding S1P modulators (83%).</div><div>Key findings Increased preference for HETs as first-line treatment, even in patients with favorable prognosis (67% to 23% reduction in low-efficacy therapy use; <em>P</em> <!--><<!--> <!-->.05). Dominance of anti-CD20 agents (ocrelizumab/ofatumumab) as preferred options for treatment escalation and cladribine failure. Significant decline in alemtuzumab use following other therapy failures (72% to 44%; <em>P</em> <!--><<!--> <!-->.05). No consensus on post-natalizumab strategies, though anti-CD20 was most selected (56%).</div></div><div><h3>Conclusions</h3><div>The study demonstrates a paradigm shift toward early HET use in Argentina, driven by clinical evidence and expert experience. Anti-CD20 agents have become the primary strategy, while alemtuzumab's role has diminished. These findings highlight the need for personalized treatment approaches in MS.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 2","pages":"Pages 121-127"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurologia Argentina","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1853002825000205","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
The management of multiple sclerosis (MS) has evolved significantly with the availability of high-efficacy therapies (HETs). In 2023, Argentine neurologists evaluated treatment strategies, and given new real-world evidence and healthcare system changes, utilization patterns were reanalyzed.
Objective
To assess changes in HET utilization over two years and provide recommendations for different clinical scenarios (disease activity, progression, and adverse events).
Methods
The same 18 specialists from the initial 2023 study were re-surveyed using the original questionnaire. Previous responses were compared, with consensus defined as ≥ 60% agreement. Therapies were evaluated based on efficacy and safety, excluding cost considerations.
Results
Unanimous consensus classified alemtuzumab, natalizumab, ocrelizumab, ofatumumab, and cladribine as HETs, while excluding S1P modulators (83%).
Key findings Increased preference for HETs as first-line treatment, even in patients with favorable prognosis (67% to 23% reduction in low-efficacy therapy use; P < .05). Dominance of anti-CD20 agents (ocrelizumab/ofatumumab) as preferred options for treatment escalation and cladribine failure. Significant decline in alemtuzumab use following other therapy failures (72% to 44%; P < .05). No consensus on post-natalizumab strategies, though anti-CD20 was most selected (56%).
Conclusions
The study demonstrates a paradigm shift toward early HET use in Argentina, driven by clinical evidence and expert experience. Anti-CD20 agents have become the primary strategy, while alemtuzumab's role has diminished. These findings highlight the need for personalized treatment approaches in MS.
期刊介绍:
Neurología Argentina es la publicación oficial de la Sociedad Neurológica Argentina. Todos los artículos, publicados en español, son sometidos a un proceso de revisión sobre ciego por pares con la finalidad de ofrecer información original, relevante y de alta calidad que abarca todos los aspectos de la Neurología y la Neurociencia.