title: Balancing Early Aggression Against Risk of Progression in Multiple Sclerosis.
abstract: Multiple sclerosis is a chronic demyelinating disease characterized by focal and diffuse inflammation of the central nervous system resulting in significant physical and cognitive disabilities. Disease-modifying therapies targeting the dysfunctional immune response are most effective in the first few years after disease onset, indicating that there is a limited time window for therapy to influence the disease course. No evidence of disease activity is emerging as a new standard for treatment response and may be associated with improved long-term disability outcomes. An aggressive management strategy, including earlier use of more potent immunomodulatory agents and close monitoring of the clinical and radiologic response to treatment, is recommended to minimize early brain volume loss and slow the progression of physical and cognitive impairments in patients with relapsing-remitting multiple sclerosis.
authors.affiliation: 1Centre hospitalier de l'Université de Montréal,Montréal,Québec,Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
authors.affiliation: 2Montreal Neurological Institute,Montréal,Québec,Canada.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Giacomini
authors.affiliation: 3Queen Elizabeth II Halifax Infirmary,Halifax,Nova Scotia,Canada.
authors.forename: Virender
authors.initials: V
authors.lastname: Bhan
authors.affiliation: 4St Michael's Hospital,Toronto,Ontario,Canada.
authors.forename: Marika
authors.initials: M
authors.lastname: Hohol
authors.affiliation: 5Novartis Pharmaceuticals Canada Inc.,Dorval,Québec,Canada.
authors.forename: Robyn
authors.initials: R
authors.lastname: Schecter
mesh_terms: D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy*
chemical_list: D007155:Immunologic Factors
keywords: aggressive management; disease-modifying therapy; multiple sclerosis; progression