#184: MS treatment across the disease course – treat early, think long-term, don't give up too soon with Prof. Klaus Schmierer

Read the full blog post and interview here:
https://ms-perspektive.de/en/184-klaus-schmierer/

How early should MS treatment start, how strongly should we treat, and is there ever a point when it becomes "too late" to protect meaningful function?

In this episode, I speak with Prof. Klaus Schmierer, Professor of Neurology at Queen Mary University of London and honorary consultant neurologist at Barts Health NHS Trust, about MS treatment across the entire disease course. We look at the very beginning of MS, different treatment strategies, advanced disability, and the question of what can still be preserved at each stage.

In this episode, we discuss:

• why MS treatment should start as early as possible once the diagnosis is sufficiently secure
• why diagnostic accuracy remains essential, especially when MRI findings can be misleading
• what the AttackMS trial is investigating with very early high-efficacy treatment
• why the traditional escalation approach may sometimes allow avoidable damage to occur
• the difference between continuous treatment and immune reconstitution
• for whom immune reconstitution approaches may be particularly suitable
• how to balance treatment risks against the risks of insufficiently controlled MS
• why "mild MS" is difficult to predict reliably in an individual person
• why people with advanced disability are still underrepresented in MS trials
• what ChariotMS is investigating in people with advanced MS
• why arm and hand function can be crucial for independence even when walking is already severely limited
• why a high EDSS score alone should not automatically be a reason to stop disease-modifying treatment
• whether there may be several different treatment windows across the disease course
• which developments Klaus would like to see in the next five years, including better biomarkers, neuroprotection, repair and more equitable access to treatment

Klaus' key message is: treat early, think long-term and don't give up too soon.

Links & resources

Full blog post and interview:
https://ms-perspektive.de/en/184-klaus-schmierer/

AttackMS – how early should we use highly effective DMTs?
MS Society UK:
https://www.mssociety.org.uk/research/latest-research/research-blog/attackms-how-early-should-we-use-highly-effective-dmts

ChariotMS – can cladribine slow worsening in advanced MS?
MS Society UK:
https://www.mssociety.org.uk/research/explore-our-research/search-our-research-projects/chariotms-can-cladribine-slow-worsening

#002: How can a rapid and clear MS diagnosis be made?
https://ms-perspektive.de/en/002-diagnosis/

#179: Multiple sclerosis without the noise – Dominic Shadbolt
https://ms-perspektive.de/en/179-dominic-shadbolt/

#125: The MS Brain Health Strategy with Prof. Barbara Willekens
https://ms-perspektive.de/en/125-barbara-willekens/

#040: Autologous stem cell therapy (aHSCT) in MS with Prof. Roland Martin
https://ms-perspektive.de/en/40-ahsct-roland-martin/

#049: CogeX study insights for progressive MS with Prof. Anthony Feinstein
https://ms-perspektive.de/en/049-cogex-anthony-feinstein/

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See you soon and try to make the best out of your life,
Nele

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