{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:27:35Z","timestamp":1761920855491},"reference-count":59,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T00:00:00Z","timestamp":1614729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T00:00:00Z","timestamp":1614729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Charit\u00e9"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nervenarzt"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:sec>\n                <jats:title>Hintergrund<\/jats:title>\n                <jats:p>Bei der Multiplen Sklerose (MS) besteht ein Krankheitskontinuum vom klinisch isolierten Syndrom \u00fcber die schubf\u00f6rmig-remittierende MS zur sekund\u00e4r progredienten MS (SPMS). Es bestehen zahlreiche Therapieans\u00e4tze mit Wirksamkeit auf die schubf\u00f6rmigen und fokal-entz\u00fcndlichen Krankheitsaspekte, w\u00e4hrend die Therapie der sekund\u00e4ren Progredienz und der mit ihr assoziierten Aspekte der Pathologie weiterhin eine Herausforderung darstellt.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Ziel der Arbeit<\/jats:title>\n                <jats:p>\u00dcbersicht der aktuellen Optionen zur krankheitsmodifizierenden Therapie der SPMS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material und Methoden<\/jats:title>\n                <jats:p>Ergebnisse randomisierter klinischer Studien werden substanzspezifisch dargestellt und bewertet.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Ergebnisse<\/jats:title>\n                <jats:p>Randomisierte klinische Studien zur Behinderungszunahme bei SPMS zeigten f\u00fcr \u03b2\u2011Interferone widerspr\u00fcchliche, f\u00fcr Natalizumab negative Ergebnisse. Orales Cladribin und Ocrelizumab reduzierten die Behinderungszunahme bei schubf\u00f6rmiger MS, wurden jedoch nicht gezielt in einer SPMS-Population untersucht. Positive Ergebnisse zu Mitoxantron sind f\u00fcr heutige SPMS-Patienten mit Blick auf das Nebenwirkungsprofil nur bedingt relevant. F\u00fcr das Blut-Hirn-Schranken-g\u00e4ngige Siponimod wurde in der EXPAND-Studie bei typischen SPMS-Patienten eine signifikante Reduktion des Risikos der Behinderungsprogression nachgewiesen. Subgruppenanalysen sprechen f\u00fcr eine noch h\u00f6here Wirksamkeit von Siponimod bei j\u00fcngeren Patienten mit aktiver SPMS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Diskussion<\/jats:title>\n                <jats:p>F\u00fcr den Einsatz bisheriger krankheitsmodifizierender Therapien bei SPMS besteht begrenzte Evidenz. Mit Siponimod steht eine neue Option zur Therapie der aktiven SPMS zur Verf\u00fcgung, definiert durch Sch\u00fcbe oder fokal-entz\u00fcndliche MRT-Aktivit\u00e4t. F\u00fcr die Indikationsstellung sind einerseits die fr\u00fche Erkennung einer schubunabh\u00e4ngigen Progression, andererseits die Abgrenzung der aktiven SPMS von einer nicht aktiven Erkrankung von entscheidender Bedeutung.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00115-021-01080-6","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T09:04:20Z","timestamp":1614762260000},"page":"1052-1060","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Krankheitsmodifizierende Therapie der sekund\u00e4r progredienten Multiplen Sklerose"],"prefix":"10.1007","volume":"92","author":[{"given":"Olaf","family":"Hoffmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Gold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,3]]},"reference":[{"key":"1080_CR1","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1136\/jnnp.2003.010090","volume":"75","author":"O Andersen","year":"2004","unstructured":"Andersen\u00a0O, Elovaara\u00a0I, Farkkila\u00a0M et al (2004) Multicentre, randomised, double blind, placebo controlled, phase III study of weekly, low dose, subcutaneous interferon beta-1a in secondary progressive multiple sclerosis. 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