RESUMO
The treatment of multiple sclerosis (MS) has advanced greatly since the introduction of disease-modifying therapies (DMTs) in the early 1990s. Although the DMTs have exhibited significant efficacy in relapsing-remitting MS and other forms of the disease, the degree of benefit depends heavily on patient adherence to recommended regimens. This article addresses some of the most pressing areas of unmet need in educating advanced-practice nurses, neurologists, patients, and support care partners regarding strategies that can overcome obstacles to adherence. The observations presented here are based on clinical experience with real-life cognitive, psychosocial, and cultural impediments to adherence. The article also explores the ways in which adherence may be affected by emerging therapies for MS (such as oral agents) as well as the educational needs that will arise with the further evolution of MS care.
Assuntos
Antirreumáticos/uso terapêutico , Promoção da Saúde/organização & administração , Adesão à Medicação/psicologia , Esclerose Múltipla , Educação de Pacientes como Assunto/organização & administração , Adaptação Psicológica , Administração Oral , Prática Avançada de Enfermagem/educação , Prática Avançada de Enfermagem/organização & administração , Comunicação , Empatia , Família/psicologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Injeções Subcutâneas/efeitos adversos , Injeções Subcutâneas/enfermagem , Injeções Subcutâneas/psicologia , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/enfermagem , Esclerose Múltipla/psicologia , Papel do Profissional de Enfermagem/psicologia , Apoio SocialRESUMO
The development of monoclonal antibodies (mAbs) presents an emerging, highly specific therapeutic strategy for the treatment of multiple sclerosis (MS). mAbs target selective molecules and have shown early promise, along with notable risks, in the treatment of MS and other immune-mediated diseases. The mechanism of action of the 4 mAbs under active investigation for MS (natalizumab, rituximab, alemtuzumab, and daclizumab) are reviewed, with a discussion of how mAb interaction with each target antigen may produce direct and indirect effects (proven and hypothesized) on immune cell activity, CNS-related inflammatory processes, and clinical outcomes.