F.Z.: Participation in a scientific advisory board or lecturing activity for Novartis, Roche, Celgene, AC-264613 Janssen, Novartis Pharma, Janssen Pharmaceutica, Sandoz International, F. therapy option. Alternatively, treatment can be initiated with a high-efficacy DMT already at the time of diagnosis, for example, with alemtuzumab, cladribine, natalizumab, ocrelizumab, ofatumumab, or S1P modulators (fingolimod, ozanimod, ponesimod). Data from observational studies suggest that initial treatment with a high-efficacy DMT may be associated with a lower risk of conversion to SPMS in patients with disease activity. When starting or switching treatment, it is essential to continuously monitor patients, including a thorough neurological examination and MRI of the brain at regular intervals. It is advisable to take a de-risking approach and perform a complete laboratory and vaccination status check (currently obligatory for several therapies but not for all) before starting a DMT. Furthermore, crucial questions regarding the management of MS patients in the COVID pandemic have recently sprung up. In this context, it is necessary to point out that (1) according to current data, MS patients do not have an increased risk for SARS-CoV-2 Rabbit polyclonal to Chk1.Serine/threonine-protein kinase which is required for checkpoint-mediated cell cycle arrest and activation of DNA repair in response to the presence of DNA damage or unreplicated DNA.May also negatively regulate cell cycle progression during unperturbed cell cycles.This regulation is achieved by a number of mechanisms that together help to preserve the integrity of the genome. infection or a severe course of the disease, while a higher degree of disability due to MS can nevertheless increase the risk for severe COVID-19; (2) the principles behind DMTs and their application are not fundamentally changed by the pandemic; and (3) MS patients are recommended to be vaccinated. For further guidance on treatment effects and side effects of each drug and information on necessary examinations and laboratory controls before therapy initiation or switch, we refer to the descriptions in the summary of product characteristics (SmPC) of the respective medicines. Introduction and background MS is a complex, most likely autoimmune-mediated inflammatory neurodegenerative disease of the CNS. In Germany, an estimated 250,000 people suffer from MS.1,2 The approval of several DMTs for treating different forms or stages of the disease requires us to update our knowledge base, looking at the benefits and risks of these therapies in the context of high-quality studies. This position statement (white paper) of the MSTCG (Multiple Sclerosis Therapy Consensus Group) reflects open questions on MS, the disease course, and management under DMTs in 2021, based on available scientific evidence. Our treatment recommendations are primarily applicable in German-speaking countries (regarding regulatory aspects and approvals), while the defined recommendations and treatment approaches are highly relevant for the MS community worldwide. Our knowledge about the disease has expanded in recent years, especially regarding specifics on (early) diagnosis, disease course assessment and prognosis, and options for measurability in the clinical practice. Together with the approval of and experience with various compounds and therapeutic concepts, these advances have shaped the place of AC-264613 pharmacological intervention in modern MS management. Nevertheless, it is not possible to make scientifically sound and concrete recommendations for every situation; for example, there is still insufficient evidence on the use of pharmacotherapy in radiologically isolated syndrome (RIS). Therefore, a deliberative approach tailored to the individual patient and the individual circumstances is still necessary (and reasonable) instead of categorical, rigid recommendations. The key issues addressed here relate to the timing and nature of therapeutic interventions and the approach to clinical management of MS under therapy. Our recommendations, including their rationales, represent the current state of MS management and treatment. They are intended to provide practical guidance for clinicians and a scientifically sound foundation for treatment decisions. We include recommendations on the following topics: early treatment of patients with clinically AC-264613 isolated syndrome (CIS) efficacy of DMTs treatment of patients with relapsing as well as progressive disease forms monitoring of treatment response treatment strategies for inadequate response to therapy therapy discontinuation or switch long-term effects of DMTs treatment in special situations such as pregnancy treatment strategies in the context of COVID-19 This MSTCG position statement is an initiative of members of the KKNMS, members of the BDN, members of the DGN, and members of the Austrian and Swiss neurological societies. The.