Breakthrough therapies - an end to progressive disability? Episode 88

What is multiple sclerosis and how do you recognise it?

Multiple sclerosis (MS) is a chronic autoimmune disease that attacks the central nervous system, in which the myelin sheaths of neurons are damaged [1]. The condition is most commonly diagnosed in young adults aged 20-40 years and can range from mild symptoms that do not significantly affect daily functioning to advanced stages of the disease that can lead to disability [2]. Depending on the patient, the disease may involve episodes of muscle weakness, visual disturbances, balance problems or even difficulties with cognitive function[3]. These symptoms may occur suddenly or gradually increase[14]. It is worth remembering that the first symptoms of multiple sclerosis are sometimes not obvious[15].

How do doctors diagnose multiple sclerosis?

Diagnosing multiple sclerosis is a process that requires accuracy, as the symptoms of this disease can be subtle and easy to miss at first. Moreover, they can resemble other conditions, making it necessary for the neurologist to put the various pieces of the puzzle together to arrive at an accurate diagnosis. The medical history plays an important role - the doctor asks about the nature of the symptoms, their frequency and moments of severity [4,5].

An important tool in diagnosis is MRI. This test allows imaging of brain changes that are characteristic of MS. Sometimes additional investigations such as lumbar puncture are performed. [6,7].

Highly effective therapy - HETA

Multiple sclerosis has undergone a huge shift in treatment with the introduction of high-efficacy therapies, known as HETAs (Highly Efficacy Treatment Agents). In the past, a diagnosis of MS was often associated with a vision of gradual loss of function. Today, with HETA therapies, it is possible to effectively stop disease activity at an early stage, which can allow patients to remain fully active for many years [8].

"Multiple sclerosis is a chronic disease, but we are able to treat it (...) the patient can lead the kind of life they have led before. Our patients at the moment have access to very good therapies"- says Dr Elżbieta Jasińska, MD. The most important thing is to act quickly and effectively. "What science brings us is the information that highly effective drugs can and even should be used at the very beginning - right after diagnosis. This is because inflammatory processes dominate at the beginning. At this stage of our knowledge, we have drugs whose main mechanism is anti-inflammatory. So we aim to stop the inflammatory process. On the other hand, if the patient progresses to the stage of neurodegenerative changes, then unfortunately our options are limited," the interviewee points out.

HETA as first-line therapy

From the end of 2023, Polish patients with multiple sclerosis can benefit from a breakthrough change in treatment - highly effective therapies are available at an early stage of the disease, as part of first-line treatment. This is a huge step forward that allows doctors to apply the most advanced therapies as soon as the diagnosis is made, making it possible to stop the progression of the disease before it causes irreversible changes in the body [9,10,11].

The possibility of implementing HETA at an early stage of the disease is in line with international standards developed by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN). This position is also supported by Polish experts, who point out that treatment with highly effective drugs as first-line therapy is not only an opportunity for better therapeutic outcomes, but also a response to patients' needs [12, 13].

Personalisation of treatment - a decision made together with the patient

A personalised approach is fundamental in the treatment of MS - it is not only the choice of drug, but also the adaptation of therapy to the patient's lifestyle and plans[16]. As Dr Elżbieta Jasińska emphasises, the personalisation of treatment is based on a frank conversation during which the doctor and patient decide together on the best course of therapy.

The patient should feel that they have a say in what happens to their health, Dr Jasinska points out. This is particularly important in situations that require a special approach, such as women planning a pregnancy, 'When we make a diagnosis of multiple sclerosis and a young woman sits in front of me we have to take all her life plans, needs, education, profession into account when choosing a therapy. We do this together. My role is to present to the patient what the options are, how the different groups of drugs work and what goals we can achieve with them (...) Moreover, the expert adds that multiple sclerosis does not exclude breastfeeding "we have drugs that are completely safe for our breastfeeding mothers," concludes Dr Jasinska.

The final choice of therapy, however, is more than just a medical issue. It is also about trust, which is built through open conversation. As Dr Jasinska notes, when a patient understands their disease and feels they have a say in their treatment, they are more likely to comply with recommendations, which translates into better outcomes and greater psychological comfort.
Curious about the topic? Go to: www.zapytajosm.pl

The 'Patient First' programme is available on multiple platforms, including Spotify and Google Podcasts.
The episode's partner is Novartis Poland. FA-11352557/I 2025