The recent demonstration that low doses of Interferon heta-lh (IFN-β-lb) significantly reduce the risk of developing clinically definite multiple sclerosis (MS) in patients with clinically isolated syndromes suggestive of MS gives us the opportunity to start treatment in the early phases of the disease. There is much evidence from various sources that early treatment may give substantial advantages to patients. The extension phase of the PRISMS study confirmed that, in relapsing-remitting MS (RRMS). IFN-β maintains its beneficial effect on disease activity after four years of therapy and demonstrated the importance of the dosage. The European-Canadian MR! study recently documented that patients with RRMS may also benefit from glatiramer acetate. The beneficial results of intravenous immunoglobulins in these patients have been obtained in a class 1 clinical trial, but most clinicians believe that further studies of that treatment are necessary. In secondary progressive MS. the efficacy of IFNs has been demonstrated by two class I clinical trials performed in Europe and in the United States. Treatment significantly reduced disease activity and delayed the progression of disability, although it is questionable whether the effects on progression are fully explained by the reduction of disease activity, or if IFNs actually influence the "degenerative processes" that characterize the progressive phase. Intensive immunosuppression is an alternative for patients with very active disease not responding to immunomodulatory treatment. Based on the positive results of a major clinical trial and some other smaller studies, mitoxantrone has been recently approved by the FDA. In a tew selected patients with very aggressive disease, the possibility of stem cell transplantation should be considered.
|Number of pages||1|
|Publication status||Published - 2001|
ASJC Scopus subject areas
- Clinical Neurology