{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:05:05Z","timestamp":1780459505761,"version":"3.54.1"},"reference-count":136,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Multiple Sclerosis (MS) is a chronic disease with significant clinical and radiological heterogeneity. This fact, together with the increased number of disease-modifying treatments available, poses challenges in the therapeutic decisions and for the overall management of the disease. In this study, an expert panel on MS from Greece aimed to formulate a consensus, in order to provide recommendation on disease-modifying treatment (DMT) initiation and switching, as well as de-escalation strategies in Relapsing MS (RMS). Methods: The study followed two-round voting based on a modified Delphi setting. A questionnaire was constructed by a subgroup of five experts (core group) and was subsequently administered in a printed form to a group of 12 MS experts in total (panel) in a face-to-face meeting. Consensus required at least 80% agreement within the panel in order to signify strong consensus. Results: The panel agreed that the overall therapeutic plan (DMT choice) must take into consideration the degree of disease activity (low\/moderate\/high). In certain cases with suboptimal response to a moderate-efficacy DMT, a horizontal switch to another moderate-efficacy DMT may be a valid strategy. However, in cases exhibiting disability accumulation, therapy escalation should be preferred. The concept of de-escalation was suggested as an alternative strategy for cases with stable disease receiving a high-efficacy long-term DMT in the long term. Due to the possibility of rebound phenomena with certain medications (such as fingolimod and natalizumab), a bridging strategy could be applied in cases of family planning and drug-related adverse events (such as lymphopenia and hepatotoxicity), especially in PwMS with recent inflammatory activity. Conclusions: Although novel biomarkers may soon help clinicians predict future disability accumulation, currently, regular and detailed patient monitoring seems to be the optimal way to guide clinicians\u2019 decisions on treatment changes.<\/jats:p>","DOI":"10.3390\/brainsci16060580","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:37:26Z","timestamp":1780454246000},"page":"580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Building Towards Initiation, Moderation, De-Escalation and Cessation of Disease-Modifying Treatments for Multiple Sclerosis in Greece: An Expert Panel Consensus Meeting"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-5163","authenticated-orcid":false,"given":"Marina Kleopatra","family":"Boziki","sequence":"first","affiliation":[{"name":"Multiple Sclerosis Center, 2nd Neurological University Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4737-3707","authenticated-orcid":false,"given":"Christos","family":"Bakirtzis","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, 2nd Neurological University Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8672-7619","authenticated-orcid":false,"given":"Harry","family":"Alexopoulos","sequence":"additional","affiliation":[{"name":"Department of Cell Biology & Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, 15701 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efthimios","family":"Dardiotis","sequence":"additional","affiliation":[{"name":"Neurology Clinic, University General Hospital of Larissa, University of Thessaly, 41334 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-7477","authenticated-orcid":false,"given":"Maria-Eleftheria","family":"Evangelopoulos","sequence":"additional","affiliation":[{"name":"Demyelinating Disorders Clinic, 1st Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotirios","family":"Giannopoulos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Kostadima","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Kouremenos","sequence":"additional","affiliation":[{"name":"Neurology Department, 251 Hellenic Air Force General Hospital, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panos","family":"Stathopoulos","sequence":"additional","affiliation":[{"name":"Demyelinating Disorders Clinic, 1st Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaia","family":"Tsimourtou","sequence":"additional","affiliation":[{"name":"Neurology Clinic, University General Hospital of Larissa, University of Thessaly, 41334 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8925-3327","authenticated-orcid":false,"given":"Dimitrios","family":"Tzanetakos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Iliopoulos","sequence":"additional","affiliation":[{"name":"Neurology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-3301","authenticated-orcid":false,"given":"Nikolaos","family":"Grigoriadis","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, 2nd Neurological University Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1093\/brain\/awab132","article-title":"Deep grey matter injury in multiple sclerosis: A NAIMS consensus statement","volume":"144","author":"Ontaneda","year":"2021","journal-title":"Brain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S1474-4422(22)00009-6","article-title":"Serum neurofilament light chain for individual prognostication of disease activity in people with multiple sclerosis: A retrospective modelling and validation study","volume":"21","author":"Benkert","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1756286420969016","DOI":"10.1177\/1756286420969016","article-title":"Aging and efficacy of disease-modifying therapies in multiple sclerosis: A 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