(Adnkronos) - “Si dovrebbero utilizzare sempre i farmaci ad alta efficacia perché hanno dimostrato chiaramente una prevenzione dei processi di danno della malattia rispetto a quelli di moderata efficacia”. Così Massimo Filippi, professore ordinario università Vita e Salute San Raffaele di Milano, in occasione del 54° Congresso Sin - Società italiana di neurologia, in svolgimento a Roma fino al 12 novembre.
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00:00In the treatment of multiple sclerosis, it is more and more often heard of therapies that modify the disease. What do you mean exactly?
00:13Therapies that modify the trajectory of the accumulation of disability of the disease. So they are not therapies that act on the acute event, such as relapses, such as cortisone, but they are preventive therapies that prevent the physiological events that lead to the accumulation of disability.
00:33We have 20 of these, as I said in the press conference, and they must be used according to the characteristics of the patient. The real problem is not having therapies available, but having the possibility that neurologists can use them in the best possible way, without interference from regulatory agencies and politicians.
00:54We should always use high-efficiency drugs, because they have clearly demonstrated a prevention of the damage processes of the disease, compared to those of moderate effectiveness. When I say this, it means that the disease occurs between the ages of 20 and 30, and at the age of 30-40 the subject can be in a wheelchair. If I allow him to live a normal life, you understand that it is not a small thing, and this seems to be allowed by high-efficiency drugs.
01:21I would give it to everyone, because the pathological processes of the disease are present in different quantities in all patients. At least the subordinate, as the lawyers say, I would propose it for those who have negative prognostic factors, where I know that in the next 5-10 years something will certainly happen and something unpleasant.
01:40Giving high-efficiency drugs immediately means bending the curve of accumulation and disability of the disease. So our hope is that the patient, the disease is not cured, because we still do not know the cause, but the patient will be fine for the rest of his life, or at least for decades.
01:57Is the obstacle represented by the costs of therapies?
02:01I don't think so. It is represented in a way, how to say, little aware of the costs. It is obvious that these drugs cost a little more, but there is also a cost not to treat.
02:12So, if I give a drug that changes the natural history and I spend a little more, the disease starts 20 years. If I have a disability 2, which means the absence of disability, the patient costs 22,000 euros a year at the National Health Service.
02:28If I have a disability 6, which means walking with a stick, it costs 65,000 euros a year. The life expectancy is now around 85 years. If for 60 years, instead of spending 65,000 euros, I spend 22,000 euros.
02:42There are things that are not even bought with the credit card, as an advertisement said. I get the money. So the problem is who spends the money.
02:54So if the money has to be spent by the National Health Service, it is a problem. If the families have to spend it, with the caregivers, the assistance, the hours, the working days lost by the caregiver, then this is fine.