The treatment of multiple sclerosis (MS) has undergone significant changes since the first disease-modifying therapy (DMT) drug was introduced. Currently, 19 original DMT drugs are registered in the European Union. The choice of optimal therapy is becoming increasingly challenging in the absence of reliable biomarkers on the basis of which disease progression and prognosis can be determined. In addition, longer availability and a growing number of drugs used in MS mean that doctors and patients may have to change therapy when the treatment is ineffective or is associated with the occurrence of adverse effects. The ageing of the MS population, comorbidities, and administration of other drugs during DMT should also be considered. This paper presents recommendations for initiating, monitoring, changing and possibly discontinuing DMT.

自第一种改变病情疗法（DMT）药物问世以来，多发性硬化症（MS）的治疗方法发生了重大变化。目前，已有19种原创DMT药物在欧盟注册。由于缺乏可靠的生物标志物来确定疾病的进展和预后，选择最佳疗法变得越来越具有挑战性。此外，用于多发性硬化症的药物上市时间越来越长，数量越来越多，这意味着当治疗无效或出现不良反应时，医生和患者可能不得不改变治疗方法。此外，还应考虑多发性硬化症患者的老龄化、合并症以及在DMT治疗期间使用其他药物等因素。本文就DMT的启动、监测、改变和可能的停药提出了建议。