title: Variations in multiple sclerosis practice within Europe - Is it time for a new treatment guideline?
abstract: In the past 5 years, the combination of developments in diagnostic strategy and approval of new disease-modifying therapies has provided an opportunity to achieve dramatic improvements in patient outcomes in multiple sclerosis (MS). However, across Europe there are several factors that may prevent patients from receiving the best therapy at the appropriate time, and there is variation among countries in terms of which of these factors are most relevant. Here, we review current MS clinical practices in a number of countries in the European Union to identify differences regarding initiation of treatment in patients with clinically isolated syndrome or relapsing-remitting MS, and differences in the timing of treatment switch or escalation. While recognizing that policy is not static in any country, we believe that patients' interests would be better served if a European treatment guideline was developed. Such a guideline could both inform and be informed by national policies, facilitating the dissemination of best clinical practice internationally.
authors.affiliation: Department of Neurology, kbo-Isar-Amper-Klinikum München-Ost, Ringstrasse 56A, 85540 Haar, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Marziniak
authors.affiliation: CHU de Limoges Hôpital Dupuytren, 2 Avenue Martin Luther King, 87042 Limoges, France.
authors.forename: Karima
authors.initials: K
authors.lastname: Ghorab
authors.affiliation: Department of Neurology, Poznań University of Medical Sciences, Poznan 49, Przybyszewskiego St., 60-355 Poznan, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kozubski
authors.affiliation: Aalborg University Hospital, Neurologisk Afdeling, Ladegaardsgade 5, 8. Sal, 9000 Aalborg, Denmark.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pfleger
authors.affiliation: Hospitais da Universidade de Coimbra, Serviço de Neurologia Centro, Rua Fonseca Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Lívia
authors.initials: L
authors.lastname: Sousa
authors.affiliation: Salford Royal NHS Foundation Trust, Neurosciences Department, Stott Lane, Salford M6 8HD, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Vernon
authors.affiliation: Centro Studi Sclerosi Multipla, Ospedale S. Antonio Abate, via Pastori 4, 21013 Gallarate, VA, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Zaffaroni
authors.affiliation: Department of Neurology and Institute of Physiology, I - Neuropathophysiology, Albert-Schweitzer Campus 1, Gebäude A10, 48149 Münster, Germany. Electronic address: sven.meuth@ukmuenster.de.
authors.forename: Sven G
authors.initials: SG
authors.lastname: Meuth
mesh_terms: D005060:Europe; D054625:Healthcare Disparities; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
keywords: Diagnosis; Disease-modifying therapy; Outcome; Treatment escalation; Treatment switch