Advances in disease-modifying therapies for multiple sclerosis: global updates and a regional comparison between the Republic of Moldova and Romania
Introduction
The therapeutic landscape of multiple sclerosis has undergone a remarkable transformation over the past two decades. The paradigm has shifted from reliance on moderate-efficacy, first-generation injectable therapies toward earlier adoption of high-efficacy disease-modifying treatments, particularly in relapsing forms of MS. This evolution reflects an increasing focus on early intensive treatment strategies aimed at preserving long-term neurological function and brain health.
Materials and methods
This narrative review synthesizes recent global evidence on progress in disease-modifying treatments across all multiple sclerosis phenotypes, drawing from randomized controlled trials, real-world studies, and expert consensus guidelines. In addition, it includes a comparative health policy analysis assessing DMT availability, access, and implementation in Romania and the Republic of Moldova, based on national formularies, reimbursement frameworks, and care delivery models.
Results
Globally, the MS treatment algorithm has been reoriented toward early intensive treatment, supported by emerging evidence favoring high-efficacy therapies in the early disease course. While many countries have aligned their protocols accordingly, regional discrepancies persist. Romania, as an EU member, has expanded patient access to 16 reimbursed therapies and biomarker-driven monitoring, and has developed a network of specialized Multiple Sclerosis centers. Conversely, the Republic of Moldova faces structural and economic barriers that restrict access to high-efficacy treatments, advanced diagnostics, and multidisciplinary care—factors contributing to delayed treatment and suboptimal outcomes.
Conclusions
Understanding both global innovations and regional realities is necessary to place current Multiple Sclerosis care in context. Further advancements in science, health policy, and infrastructure will ultimately determine how effectively different nations can convert therapeutic progress into actual improvements in patient outcomes.
Stroke care indicators in the Republic of Moldova – the RES-Q registry
Introduction
There were no data on in-hospital stroke care indicators until Moldova's accession to the international Registry of Stroke Care Quality (RES-Q) platform in 2016. The aim of this paper was to assess the acute stroke care quality in Moldova based on the data of the RES-Q registry.
Material and methods
We analyzed the data of all patients with acute ischemic and hemorrhagic stroke of the RES-Q from 15 Moldovan hospitals. Data were collected for one month each year, during a 3-year period (2017-2019). Data analysis was performed between hospitals according to their access to a brain CT facility for Moldovan participating hospitals. Additionally, Moldovan data were compared with other three ESO-EAST (European Stroke Organization Enhancing and Accelerating Stroke Treatment) project countries: Romania, Lithuania, and Georgia.
Results
A total of 1660 patients were recruited in the study, mean age of 68 years (49% men). Moldova registered poorer results in number of brain CT performed (81% [95% CI 79-84%]), dysphagia screening (29% [95% CI 27-32%]), IV thrombolysis performed (3% [95% CI 2-4%]), administration of anticoagulants (44% [95% CI 39-49%]) and statins (42% [95% CI 39-45%]) at discharge, in-hospital stroke mortality (17% [95% CI 15-19%]). Within Moldova the stroke care quality was driven by the access to CT scan.
Conclusions
Our study highlighted some serious gaps of in-hospital stroke care performance in Moldova, such as the lack of CT scans in many public hospitals, the absence of a national stroke center network, extremely low accessibility of IV thrombolysis and unsatisfactory implementation of secondary stroke prevention treatment.