Neurone Vol. 17 N° 2 Page 14

Neurone

Vol 17

N°2

2012

tique, scrupuleux et au long cours des
patients.
Les algorithmes d'escalade thérapeu-
tique seront modifiés avec plusieurs
questions cruciales à élucider systéma-
tiquement. Quand démarrer un traite-
ment? Quel traitement choisir en
première intention? Quelle sera la défi-
nition de sa réponse thérapeutique et de
son échappement? Quel traitement
choisir en 2

ligne si la maladie n'est

pas suffisamment contrôlée? A moyen
terme, en raison de leur efficacité et de
leur profil de sécurité, il est probable
que les traitements classiques de pre-
mière ligne injectables garderont une
place importante dans le paysage théra-
peutique, en particulier pour les pa-
tients qui présentent une maladie pré-
coce ou peu active. Par ailleurs, si les
profils de sécurité se confirment et le
permettent, les traitements oraux pren-
dront sans doute une place de plus en
plus importante dans le paysage théra-
peutique et le fingolimod, approuvé en
Belgique depuis le 1

février 2012,

pourrait ainsi être dans un premier
temps le plus utilisé avant d'être sup-
planté par des molécules héritières plus
sélectives des récepteurs S1PR-1 afin
d'en limiter encore les effets secon-
daires. Le futur devrait voir émerger des
traitements oraux à bon profil de sécu-
rité comme le BG-12 ou le laquinimod
en première ligne, au détriment pro-
gressif de l'usage des traitements injec-
tables.

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