Current and Emerging Treatment Strategies for Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that is characterized by central nervous system inflammation, demyelination, and axon loss. The clinical hallmarks of MS include a pattern of alternating relapses and remissions, and progression of permanent neurologic disability. Several subtypes of MS have been described on the basis of the initial clinical presentation and long-term course of disability. Longitudinal studies of the natural history of MS have identified several factors that are associated with poor prognosis, including greater disability at the time of evaluation, older age at onset, and a greater number of attacks during the first few years. Recent guidelines for the diagnosis of MS have incorporated magnetic resonance imaging (MRI) findings from the brain and spinal cord, which are also important prognostic markers early in the disease course. Steroids (eg, oral or intravenous methylprednisolone) have long been used to treat acute exacerbations of MS, although it is unclear whether they significantly alter the longterm course of the disease. Plasma exchange is effective treatment for attacks in some patients who do not respond to steroids. First-line diseasemodifying treatments for MS include 3 formulations of interferon (IFN) β (subcutaneous IFNβ-1a administered 3 times/week; intramuscular IFNβ1a administered once/week; and subcutaneous IFNβ-1b administered every other day) and glatiramer acetate. All of these agents have reduced relapses and MRI measures of disease activity in patients with relapsing MS. Some studies have suggested that more frequent, higher-dose IFNβ regimens may be superior to less frequent IFN administration. Because of the risk of potentially serious adverse events, natalizumab and mitoxantrone are usually reserved for patients who do not respond adequately to other treatments. Many new MS treatments are being evaluated in clinical trials, including oral immunomodulating agents and novel therapies that are intended to prevent neurodegeneration. (Adv Stud Med. 2008;8(5):144-154)