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Interview with Giancarlo Comi: Treatment Optimization of Multiple Sclerosis

Comi Treatment Optimisation-HD

According to Professor Comi, there had been enormous advances in multiple sclerosis treatment since 1993, when interferon beta-1b was standard therapy. It was now possible to optimize and customize treatment and to maximize the benefits and minimize the risks for the individual patient.

Professor Comi remarked that predictive factors were the absolute prerequisite for personalization. These factors were never perfect, but were useful. They included the natural history of the disease, the available information on the brain and spinal cord, and information from electrophysiological techniques. If the prognostic profile was very poor, the patient would be given more aggressive treatments; when the prognosis was better, the patient would be given less aggressive treatment. For intermediate cases, the decision was more difficult.

Successful treatment was only possible if the patient was actively involved, as compliance was a key factor.

Professor Comi emphasized that greater organization and a multidisciplinary approach had also become essential. In the past, many patients were followed by individual neurologists, often in private practice. They now had new drugs and new risks, such as the risk of infection or the risk of death. They needed to be able to detect these risks as quickly as possible. It was essential to have a variety of experts to give their opinions, e.g. cardiologists, ophthalmologists, urologists or psychiatrists. Responses must be possible at all hours. Older doctors had to keep up with new information. It was his impression that a lot of patients were undertreated. The more complex the treatment, the greater was the need for education.

Professor Comi is in the Department of Neurology in Milan University di Vita.

This interview has been recorded on 30th September 2015 at the San Raffaele Hospital, Milan, Italy.