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Klin272480400107446583131
Farmakol2871804001074178105179220258305325
Farm.3211804001074279105180196
2025;39(3):165-1703422804001074487129173186230272296338359374411450493520559596637
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KLINICKÁ4182804001074588109168189242288346
FARMAKOLOGIE4546804001074191138210265312372414474533554598
A51618040010753
FARMACIE5231804001074291138211265317337380
16556558020012657111168
PŘEHLEDOVÉ4549200012660124182256312369444520587645
ČLÁNKY5216200012660115187259327395
Léčba38063600106296196132172
polymorbidních399436001063273105138191232268304322361402420454495
pacientů450536001063369103120152193226267
s4788360010630
roztroušenou483436001063474106139175216257289321362403444
sklerózou52943600106306697129165206237276317
Léčba3409200298123248356499624
polymorbidních101392002981432813454706768139031044110812491389145215581698
pacientů27599200298144269375440564705790929
s34011800298104
roztroušenou49311800298912283384285196577958981023116313001438
sklerózou1980118002981042333004265166547649011039
Martina3401580013793152194236267331389
Petrášová1,7511580013764120161204261309373429487123115900803651
2,129515900803613331580013729
Jan13841580013745103167
Kočica1,15731580013768129179210259318188315900803651
2,194715900803654
32014159008036
1Lékařská3401740078333711740013352106158211246290341395
fakulta,789174001333286136197222258311334
Masarykova11461740013389142184238273328380438490543
univerzita,17121740013361121146198252288336362398451474
Brno2209174001336095156216
2Neurologická3401890078333731890013372128188223283309369431456505555609
klinika,1005189001335279104164189240294316
Fakultní13451890013353101152213238274334359
nemocnice17281890013361116207267317377402451504
Brno2256189001335995156216
3Ústav3402040078333732040013371113150203254
laboratorní650204001332678140201237290325384420481506
medicíny,11792040013392147210235283308369418435
Fakultní16382040013353102152213238274334359
nemocnice20212040013361116207267317377402451504
Brno2549204001335995156216
Přehled340255001215384132187210259315
shrnuje675255001214094125180234256306
praktické1000255001215789137182217239283328376
zásady1396255001214391129177233280
léčby1695255001212473118173219
polymorbidních19332550012157112135182265319351407430485539561605659
pacientů26122550012157104148170219274305359
s29912550012139
roztroušenou3050255001213386127162193247301339388443497551
sklerózou.3621255001213985109158340269001213386127181235255
Komorbidity6142690012154107190244276332355410432464513
jsou1146269001212563117171
časté1336269001214593131164212
a15672690012148
zásadně1635269001214391129177233287337
ovlivňují19912690012155101124146193248302325347
diagnostiku,2357269001215779125181235289327360382428482502
prognózu2878269001215789142198253307347402
i32992690012123
volbu33422690012148101124179234
chronické3595269001214599130184340283001215678122168217
léčby584283001212373118174220
(DMT);831283001212894174223253271
radiografickou1129283001213381137159214270302350379404448494548602
aktivitu1758283001214995130152200223256310
u20952830012156
vaskulárních2177283001214997135181236259306338393416460515
komorbidit27182830012148101184239271328351407430462
je3207283001212474
proto3308283001215789143176229
nutné35642830012156110143197247
interpretovat340297001212378109157189245277326359412458505537
v9022970012148
kontextu9752970012147100155186234280315369
dalších13692970012157104126164186230284
biomarkerů.1678297001215779133216263295341389420475494
U21972970012165
vysoce2287297001214898136191235283
aktivních2595297001214994129151199254276319373
forem2994297001212983115163246
má32652970012184131
své3421297001214088136
místo35822970012183105143176229
časná340311001214592130184231
vysoce589311001214898137191235283
účinná890311001215599121175230277
terapie1184311001213482114161217240289
(např.1491311001212879126182214228
anti-CD2017373110012149103134156187247312359408
protilátky,2163311001215789142174196219266297343392407
kladribin2588311001214771118173205227283306360
či2966311001214566
natalizumab),30503110012156103134182205227268322405452508532550
vždy3618311001214892147194
s3403250012139
důslednou3953250012156109146168217273326380433
farmakovigilancí.844325001212976107189236281333379401456478499546600643665684
Překryvné1543325001215384132177210259309363412
diagnózy1971325001215677124178232286326374
lze2361325001212364113
bezpečně24893250012157106148204253297351400
adresovat29043250012148103134182220274319366397
paralelně33173250012156104135182204253275329377
na37103250012155102
komorbiditu3403390012147100182236268324347403425457511
cílenou86933900121456791141195250304
léčbou1192339001212372117172227282
(např.1492339001212980127183215229
anti-CGRP17403390012148102134156186247307361413
u21723390012155
migrény),22463390012183105160192241295340366383
zatímco2648339001214392123145227272324
některým29913390012155105151186234266315398
monoklonálním340833900121831381922462933173713403530012155102125179201283
protilátkám640353001215789143175197219266297343391473
je1130353001212574
vhodné12213530012148103157213268317
se1555353001214089
u16613530012156
roztroušené1734353001213286127161193246301339388443492
sklerózy2243353001214085109159190244285334
vyhnout2594353001214898153207261315347
(např.2959353001212879126182214228
anti-TNFα).32043530012149103134156187232297345398424441
Věk36633530012155102148
a3403670012148
imunosenescence4043670012124106159214268306355410459498542590644688736
snižují1156367001214094116157211234256
očekávaný1428367001215599147193241287334388433
efekt1877367001215079128174209
některých21023670012155104151185234265315357411
DMT25293670012167146195
a27403670012148
zvyšují2804367001214392142180234257279
rizika;309936700121325597119164213231
u33463670012155
stabilních3417367001214073120176199221275297341395
nemocných3403810012155105188242286341385428482
lze842381001212465114
uvažovat9773810012155102150192245291339370
o13683810012155
opatrné14433810012155111159190222276326
de-eskalaci,17893810012156106138190228274322344391435457476
zároveň2286381001214291123176222270325
však2631381001214886134180
i28313810012123
ve2875381001214896
vyšším2991381001214898136174196278
věku3290381001214896142196
vídáme3506381001214871126173256305
relapsy340395001213381104151207245293
a6503950012148
je716395001212474
třeba807395001213465114170217
léčbu1042395001212473118173228
individualizovat.1287395001212478134156203226281335382405426468522568616647667
Doporučen19723950012167121177232264319363411465
je2455395001212473
systematický2546395001214087125158207289336368390433479528
přístup3092395001215789111149182235291
s34013950012139
využitím3458395001214898153195217249271353
standardizovaných340409001213971119172227273304358380421474519566620663706759
check-listů,1114409001214498146190235262285307344376429449
aktivním1578409001214892127148195249271352
vyhledáváním1945409001214897151173222277324368415469490571
a25324090012147
léčením2595409001212372116163217238320
komorbidit2930409001214698180233265320342397418450
a33954090012148
multidisciplinárním34584090012183136158189211265287324340423001214466120143164218264294348370451
sdíleným806423001213994115139188241285367
rozhodováním1188423001213285125179232287340385432485507588
s17914230012139
pacientem18454230012157103146168216270300348429
s22894230012139
důrazem23434230012156109140186228276357
na27154230012155101
výslednou2831423001214897135156205260313367420
kvalitu3266423001214696142164185217270
života.3551423001214264110162193240260
Klíčová340439001246392121167226280334
slova:702439001244473133187241267
roztroušená997440001213389132169203259315355407464514
skleróza,1540440001214088114166200256299350372
komorbidity,19414400012148103189246280338363421445479530547
kombinovaná25174400012148103189247272328385433483540589
farmakoterapie,3136440001213080113199249297352386436470520578603654675
monoklonální3404540012183139194249297322377433481504559582
protilátky.943454001215790145178201224272304351401418
Treatment340481001245587141194231318371431467
of827481001245893
multimorbid9404810012486145172210238325383421481509569
patients15294810012460113150178231291327372
with19214810012476104141201
multiple21424810012486144172210238298326380
sclerosis2542481001244389117170209268311339383
The3404990012149103151
review505499001213279124146194264
summarises783499001213991171252298328349385433470
practical1267499001215687133175208229271317338
principles1619499001215687108161203224278300347384
for2017499001212981112
treating2142499001213363111156186207260313
polymorbid24694990012156110131176258310341395417471
patients29534990012157103133154201255284323
with3289499001217395125178
multiple34804990012183135157187208262283331
sclerosis.340513001213982103151181233270291327346
Comorbidities6995130012158109190243273328349403424455475523560
are1273513001214878125
common1411513001214596177257310363
and17885130012148100154
strongly1956513001213971101153206260281326
influence2295513001212376103127179227280322369
diagnosis,2677513001215777123176229282318339375394
prognosis,3085513001215687139193246298335356392411
and35095130012148101155
the3678513001213385133
choice340527001214597150171214261
of614527001215582
chronic710527001214497127180233254296
disease-modifying1020527001215677114162208244293324406459514535562610632685739
therapy1773527001213385134164210265309
(DMT);2096527001212891169216245262
radiographic2371527001213379134155207262292338393446467509
activity2894527001214891124145191212243291
in3199527001212376
the3289527001213385134
setting3436527001214088119152173226280
of3730527001215581
vascular340541001214895132175228249295325
comorbidities685541001214597178232263318339394415446467515553
should1258541001213992145199220275
therefore1553541001213386134165213241294324372
be19455410012157106
interpreted2071541001212377107154185240271319351398453
in2544541001212377
the2641541001213386134
context2795541001214597150181228273307
of3122541001215582
additional32245410012148103157179210231284337383405
biomarkers.36495410012157781313405550012183130160205252283321340
In699555001212477
highly794555001215677131184206251
active1063555001214991125146192239
disease,1320555001215778115163209246295313
early1651555001215096127148194
high-efficacy1863555001215677130184214265292323347390437479527
therapy2408555001213386135166212267311
(e.273855500121287391
g.,283855500121567594
anti-CD2029515550012148101131152182242305351399
antibodies,33695550012148101131152207261316337386423442
cladribine,340569001214566112167197219273295348397415
or773569001215586
natalizumab)8775690012156102132179201222262315397443498521
has14175690012155101138
a15745690012148
clear1641569001214465114160190
role,1850569001213385107155173
always2042569001214869141187231269
coupled2329569001214597150205227275330
with2678569001217395126179
rigorous2876569001213354108161192245298335
pharmacovigilance.32305690012156110156187268315357409454476530551340583001212369122164211229
Overlapping5825830012169116163193215260314369390443497
conditions1092583001214596149204225255276329382418
can1524583001214491143
be16815830012157105
managed18005830012183128181227280328383
safely2197583001213986112160182227
with2437583001217495126179
parallel,26295830012157103133179200221269291309
comorbidity-targeted2952583001214495176229260314336390411442489518549595625679726758804859
treatment340597001213364111157188269318371402
(e.g.,76159700121287391156175194
anti-CGRP9745970012148102132153183242302354406
for1399597001212982113
migraine),15315970012183104158189235256310358382398
whereas19485970012174128176207255301338
some2305597001213993174223
monoclonal25475970012183136190243287308361415461482
antibodies30485970012148102132153208261317338386424
are3490597001214979127
best36365970012157106143175
avoided340611001214893144166220268324
in678611001212376
multiple7686110012183136157188209264286334
sclerosis1116611001214083104152183235272293330
(e.146061100121287392
g.,156061100121567494
anti-TNFα).16686110012148101131152182225290337388413430
Age21126110012161114162
and22886110012148101156
immunosenescence24586110012123104185238291344381430483532569612659713756802
attenuate3274611001214979112159213266312342389
the3677611001213386135
expected340625001215095151200243277324379
effect739625001215078108157200234
of992625001215582
some1094625001213992174223
DMTs13366250012167145193224
and15796250012148102156
increase1755625001212377120150198244281329
risks;210462500121335491135176193
in2317625001212377
stable2413625001214072118173195244
patients,26766250012157104134155204257288326345
cautious3041625001214591144175196249302339
de-escalation34006250012156105136187224267314335381340639001213354107161
may5196390012183130173
be7106390012157107
considered,835639001214596150187208262310341389444463
yet1316639001214795126
relapses1460639001213381103149203241289327
still180563900121397192114135
occur1958639001215598140193223
at2200639001214878
older2296639001215577132180211
ages25256390012149103151189
and27326390012148101156
therapy2906639001213386135166212267311
should3235639001214093146199221275
remain3528639001213381163209230283
individualised.340653001212376130151197219273325371392413449497552571
A9246530012161
systematic999653001213985122154201282327358378421
approach14336530012148103157188240287329382
using1828653001215592112165219
standardised2061653001213971117170224270300354374411459514
checklists,2588653001214598146189233256277313345383402
active3003653001214891124144190237
screening3254653001213982112159208261282335389
and36566530012148101155
management3406670012184130183229283332414462516546
of911667001215582
comorbidities,1017667001214597178232263318340394416447468516554573
and16146670012148102157
multidisciplinary17956670012183136158189210264286322366387441464485538584615663
shared2482667001214093139170218273
decision-making27796670012157105149170207228281335365448494539561615669
with3472667001217496127180
the3676667001213487135
patient,3406810012157104134155203257287306
focused664681001212982125178215264319
on10006810012155109
overall11266810012155100147178225246267
quality14106810012157109155177198229277
of1704681001215582
life,180368100121244572120138
is1958681001212461
recommended.2036681001213280124176257338387441495544599618
Key3406970012461113164
words:5246970012476133172232276302
multiple8466980012183138162195218274298349
sclerosis,1216698001213984108158191245285308346367
comorbidity,1604698001214599183238271328351408431464514530
drug2155698001215789144201
therapy,2377698001213388138171220276323339
combination,2737698001214598182239263318366398421476532553
monoclonal33116980012183138194249295318373429477500
antibodies.3407120012148103136159215271329352402441463
Úvod3407450014780142208279
Roztroušená4807620010950103144180212265319357406460507
skleróza1022762001093782107156189242283332
(RS)1389762001092678126154
je1578762001092271
chronické1684762001094295128180235258302340776001094391
autoimunitní460776001094598130182206285338391414447500523
onemocnění10137760010951105153233286330383432485508
centrálního1551776001094289142174207253277330353408461
nervového2140748001095097127175225268314365416
systému2577748001093680117149194271321
(CNS)2919748001092677137182208
charakterizované3148748001094091136166211254288333364387427477521566617663
zánětlivou2140762001093882132177207228248292340389
demyelinizací2545762001095095169210254276297346367405450490511
a30727620010942
postupnou31307620010950100136166215266315365414
neurodegenerací.35607620010949941431732212140776001095197150196248294325370412434454
Klíčovým261377600109497395136186229276353
mechanismem29867760010975122164215260311333369445492568
se3574776001093682
jeví3676776001092269113135
DECLARATIONS:4068257008648871301662142563043393604124625014570257008514
Declaration406827100874987120141179206244271291333375
of445727100874066
originality:45372710087406888130150192230251271298337356
The406828200853473109
manuscript418828200855891130168195227249266306329
is452828200851744
original45832820085386178117133172205222
and481628200853472112
has49392820085387299
not50502820085387699
been516128200853975110149
published532228200853977117134150177216251291
or406829300853862
submitted414529300852867108167184208234269310
elsewhere.44702930085355381117169209245269305320
Ethical406830700873764107127160198218
principles43003070087427090132165185228249287319
compliance:463330700873173134177197218256298330368387
The406831800853678116
authors420531800853475100142183208238
attest44643180085356087124153179
that466431800852465101126
their481131800852465103121146
study49783180085295595138173
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by406832900854073
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Committee464832900854179139198215239265300337
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is513232900851745
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regulations53903400085236110414516420140683510085234080120148
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authors’44343510085347397136176200229244
institutions46983510085165684109126150189213231270310338
as505635100853462
well513835100855187104122
as527935100853462
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Helsinki537036200854684102131149189224243
on406837300853878
Ethical41653730085355898115147182199
Principles43833730085376178117150167207225261290
for46923730085205983
Medical479437300855693134151183218235
Research504837300853874102139173197229268
Involving53353730085175690128146181198238278
Human406838400854685145179219
Subjects430738400853474114132168201227256
adopted458338400853474114155179215256
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WMA5198384008559116160
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Finland,47613950085355394113149190232249
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1964,528539500853771110150166
with54743950085537297139
subsequent406840600852867107136172213252288328352
amendments,443740600853493130169210269305345369398414
as486840600853462
well494840600855287105122
as508840600853362
with51674060085526993133
the53184060085236298
ICMJE543440600851759116143179
Recommendations406841700853977112153216278317359402439465483525568598
for46974170085226389
the481841700852466104
Conduct,495441700854283125168210245272290
Reporting,527541700853978121163189217236278321338
Editing,40684280085347491115132172212227
and430842800853373113
Publication443442800853776117134151183218242259298338
of478542800853859
Scholarly485742800853467106146163198221239273
Work514242800856097121155
in531042800851656
Medical537842800855693134151183218235
Journals,406843900852666105129169204221249265
updated435343900853980121155179215256
in462943900851656
December470543900854683116151211252289313
2018,503743900853673107140156
including52134390085165689106145186203243283
patient55164390085407540684500085234076116140
consent422245000853270110138174214238
where447545000855191127151187
appropriate.467745000853474115139178219243260295318354369
Conflict406846400874282124149171191223251
of433446400874065
interest44134640087196288126154192224251
and467846400873779122
financial48144640087244587125167200220258279
disclosures:51074640087416293126147188220261289327359378
None.406847500854686126162177
Funding/Support:406848900873777119162183225267291329371414457499526554574
None.406850000854686126162177
Cit.4068714008541588297
zkr:41807140085306489105
Klin42997140086416079120
Farmakol44347140086357095156192229269288
Farm.47367140086367096156174
2025;39(3):165-170492571400863775113151167205242264301321338373409446470504538575
https://doi.org/10.36290/far.2025.060406872500853962881291571721982194284725008641811004385725008514547811714345287250086387390130169206244283307330367393407447485522561577616655694
Článek40687360085415892132168202
přijat4285736008539638198132156
redakcí:445673600852359100134168199216231
24.47017360085367186
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2025486973600853672107144
Článek40687470085415892132168202
přijat4285747008539638198132156
k4456747008533
tisku:45047470085234068101141156
13.46757470085366883
10.47737470085356984
2025487274700853672107144
MUDr.4068766008759108158186202
Jan428476600872967109
Kočica,440776600874383116137170208228
Ph.D.464976600874082101152170
kocica.jan@fnbrno.cz406877800853371104121153188204222257296349371411452476516555570602634