6 research outputs found
Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS
Escalating Immunotherapy of Multiple Sclerosis
Basic disease-modifying treatment for relapsing forms of active multiple
sclerosis (MS) is now available in many countries with high prevalence rates,
for this chronic inflammatory disease of the central nervous system. Several
lines of evidence support early immunomodulatory treatment with either
recombinant interferon-beta or glatiramer acetate, and positive results from
phase III trials encourage start of treatment even in patients with clinically
isolated syndromes (CIS). However, currently available drugs for basic therapy
are only partially effective and patients may still encounter relapses or
disease progression. As treatment-refractory, clinically active MS can quickly
lead to irreversible neurological disability there is an urgent need for
effective escalating strategies. Patients with suboptimal treatment response to
basic therapy have been treated with combination therapies, cytotoxic drugs
(such as mitoxantrone and cyclophosphamide) or autologous hematopoietic stem
cell transplantation. Recently, the monoclonal antibody, natalizumab, was added
to this armamentarium. None of these strategies have been vigorously evaluated
in large randomized, controlled phase III trials with patients who failed basic
therapy. Therefore, the decision to escalate immunotherapy is still based on
limited evidence. This article will review potential candidates for intensified
immunosuppression and call for innovative study designs to better evaluate
escalating immunotherapy in MS