Research: WINGERCHUK and CARTER,

Listed in Issue 220

Abstract

WINGERCHUK and CARTER, (1)Department of Neurology, Mayo Clinic, Scottsdale, AZ. Electronic address: wingerchuk.dean@mayo.edu  (2)Department of Neurology, Mayo Clinic, Scottsdale, AZ. Electronic address: carter.jonathan@mayo.edu reviewed current and emerging disease-modifying therapies and treatment strategies for multiple sclerosis.

Background

Multiple sclerosis (MS) is a chronic inflammatory demyelinating central nervous system disease that typically strikes young adults, especially women. The pathobiology of MS includes inflammatory and neurodegenerative mechanisms that affect both white and grey matter. These mechanisms underlie the relapsing, and often eventually progressive, course of MS, which is heterogeneous; confident prediction of long-term individual prognosis is not yet possible. However, because revised MS diagnostic criteria that incorporate neuroimaging data facilitate early diagnosis, most patients are faced with making important long-term treatment decisions, most notably the use and selection of disease-modifying therapy (DMT).

Methodology

The authors conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from January 1, 1990, to August 31, 2013. The following search terms were used: multiple sclerosis, randomized controlled trials, interferon-beta, glatiramer acetate, mitoxantrone, natalizumab, fingolimod, teriflunomide, dimethyl fumarate, BG-12, alemtuzumab, rituximab, ocrelizumab, daclizumab, neutralizing antibodies, progressive multifocal leukoencephalopathy.

Results

Currently, there are 10 approved MS DMTs with varying degrees of efficacy for reducing relapse risk and preserving neurological function, but their long-term benefits remain unclear. Moreover, available DMTs differ with respect to the route and frequency of administration, tolerability and likelihood of treatment adherence, common adverse effects, risk of major toxicity, and pregnancy-related risks. Thorough understanding of the benefit-risk profiles of these therapies is necessary to establish logical and safe treatment plans for individuals with MS.

Conclusion

The authors reviewed the available evidence supporting risk-benefit profiles for available and emerging DMTs and also assess the place of individual DMTs within the context of several different MS management strategies, including those currently in use (sequential monotherapy, escalation therapy, and induction and maintenance therapy) and others that may soon become feasible (combination approaches and ‘personalized medicine’).

References

Wingerchuk DM(1) and Carter JL(2). Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies. Mayo Clin Proc. 89(2):225-40. Feb 2014. doi: 10.1016/j.mayocp.11.002. 2013. 

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