New ICD-10 codes added to clinical guidelines for multiple sclerosis

According to the definition, multiple sclerosis is a chronic demyelinating disease, which is based on a complex of autoimmune-inflammatory and neurodegenerative processes. They lead to multiple focal and diffuse lesions of the central nervous system, which results in disability of patients and a significant decrease in the quality of life.

The document added the term "aggressive multiple sclerosis". It refers to a variant of multiple sclerosis activity in which a previously untreated patient may experience one of two disease course scenarios over the course of one year of observation: the development of two or more exacerbations, each of which led to a confirmed increase in disability and was accompanied by the detection of one or more contrasting lesions, or the development of one exacerbation, which led to a stable level of expansion of the disability status scale (DSS).

The regulator also changed the level of certain CRs. For example, in all patients under 18 years of age with suspected multiple sclerosis in the absence of encephalopathy/general cerebral symptoms at onset, it is recommended to use the McDonald criteria to confirm the diagnosis. The level of this recommendation is C (level of evidence reliability - 5). Previously, the indicator was B (level of evidence reliability - 2).

In addition, in patients with multiple sclerosis (from 18 years old) during therapy of exacerbations using oral (tablet) glucocorticoids as an alternative to intravenous methylprednisolone, it is not recommended to use long courses of oral glucocorticoids (more than 5 days), including gradual dose reduction, in order to prevent the development of side effects of long-term therapy with oral glucocorticoids. Previously, the level of evidence was C (level of evidence - 5), now the indicator is listed as A (level of evidence - 2).

The Ministry of Health has also adjusted the recommended therapy. Now, for example, if a patient over 18 suffers from overactive bladder, then he is recommended to prescribe oxybutynin 5 mg twice a day or tolterodine 4 mg twice a day or 1 mg twice a day. Previously, for such symptoms, it was recommended to prescribe oxybutynin 5 mg two to three times a day or tolterodine 2-4 mg once a day.

In addition, patients with multiple sclerosis over 18 years of age with a RASI level of 4-7 points with impaired walking function are now recommended to take fampridine 10 mg orally twice a day. Previously, there was no such recommendation.

Also among the new CR are recommendations for rehabilitation. Thus, for patients over 18 years of age undergoing rehabilitation at the outpatient or inpatient stage, low-intensity laser therapy is recommended to increase functional mobility, reduce fatigue and improve the quality of life.

In April 2024, the Russian Government expanded the list of vital and essential drugs by five items at once. The updated list, among others, included two drugs for patients with multiple sclerosis - Tenexia (sampeginterferon beta-1a) for the treatment of patients with relapsing multiple sclerosis and Ivlizi (divosilimab), designed to reduce the number of exacerbations in patients with this disease.