Diversity in the course of multiple sclerosis and individualisation of therapy – analysis of the centre’s population of patients treated under the drug programme
Authors: Florkiewicz-Szufla Olga 
Published: February 2025

Introduction: Multiple sclerosis is a chronic inflammatory, demyelinating disease with a still unknown pathogenesis. It remains a condition with diverse clinical manifestations. Once inevitably leading to disability, due to disease-modifying therapies, it is now possible to halt its progression. A large number of registered molecules enables the selection of the most appropriate treatment, depending on the individual disease pattern. Aim the study: The aim of this analysis was to assess patients with multiple sclerosis treated as part of the drug programme at the centre, focusing on various aspects of the disease and treatment. Materials and methods: Medical records of 372 patients from the centre were retrospectively analysed in terms of duration of the disease and its course: clinical activity in the form of relapses, radiological activity in the form of new demyelinating lesions, progression of disability, and required treatment modifications. Groups treated for less than and more than 5 years were assessed separately, with the second group including patients with an observation period of 6–10 years, 11–15 years, and more than 15 years. The age of the analysed patients ranged from 18 to 73 years. The degree of disability was determined using the Expanded Disability Status Scale. Results: It was observed that, due to the use of disease-modifying therapies, 75.5% of patients maintained a low degree of disability, with an EDSS of 0–2.5, while 3.5% required assistance when moving, with an EDSS ≥6.0. Importantly, 78.2% of the population achieved stabilisation of the clinical condition and radiological image over the past year. Also, 41.9% of patients achieved long-term suppression of disease activity since the beginning of treatment, often using molecules belonging to the group of moderate efficacy. In some patients, the course of the disease was unfavourable despite several modifications of therapy. As disease duration increased, a decrease in the percentage of patients maintaining the status of no evidence of disease activity and an increase in the degree of disability were observed across the entire population. The most frequently used therapies included dimethyl fumarate, interferon beta, and ocrelizumab. Of all patients, 48.9% continued treatment with the first drug, while 51.1% required therapy modification– including 67.9% due to disease activity and 32.1% due to side effects. In the cohort undergoing treatment for less than 5 years, 80.9% remained on the first drug, while 19.1% required switching to another drug – 56% due to the inefficacy of the treatment and 44% due to side effects. In the group with 5 years of follow-up, all 13 patients who started treatment with high-efficacy therapies continued them with good therapeutic effect. Among the patients whose treatment was initiated with moderately effective molecules, 23.4% required a change in therapy. The safety and tolerability of the drugs remain important issues. The most frequently observed side effects in the population included skin reactions and lesions at the administration site (50.7%), flu-like symptoms (19.7%), and abnormalities in laboratory tests (14.1%). Conclusion: In the treatment of multiple sclerosis, efforts should focus on initiating therapy as early as possible to slow down the progression of disability and disease activity, while taking into account its diverse course and the individual needs of patients. The data collected so far on high-efficacy therapies confirm their effectiveness, but require further analyses and longer observation periods. A balance should be sought between the efficacy and safety profile of therapies, optimising the selection of treatments for the individual disease model.