Current and Future Disease-modifying Therapies in Multiple Sclerosis

S. Y. Lim; C. S. Constantinescu

Disclosures

Int J Clin Pract. 2010;65(5):637-650. 

In This Article

Conclusion

Increasing knowledge of the pathological process of MS has allowed us to continue developing highly selective immunomodulatory therapies. The main aim of treatment thus far has been to reduce the frequency and severity of relapses, likely delaying the onset of irreversible disability. We have only partially achieved this with current DMT. Encouragingly, the emergence of several agents showing early promise in clinical trials may soon help realise this and offer patients a wider repertoire to choose from. Alemtuzumab appears to be a promising monoclonal antibody treatment for MS; however, the results of larger phase III studies are still awaited. Rituximab may benefit patients with MS and other autoimmune conditions, although further risk/benefit analysis would be required given the reported cases of PML so far. Of the oral agents, Fingolimod and cladribine have shown positive results as disease-modifying agents in large phase III studies, although their long-term safety and efficacy in MS have yet to be established. Many more experimental therapies beyond the scope of this review are currently being explored at various stages, including autologous haematopoietic stem cell transplantation for more aggressive forms of MS, Ataticept (a recombinant fusion protein, which inhibits B-cell stimulation and proliferation, currently in phase II RRMS trials; NCT00642902 and NCT00853762) and other drugs that may offer neuroprotection. Trials that re-evaluate 'traditional' immunosuppressive agents such as azathioprine and cyclophosphamide may also provide fresh evidence for treating refractory cases of MS. The choice of disease-modifying treatment is increasingly individualised depending on the disease characteristics, patient lifestyle and drug risks/benefits. Within the established first-line therapies, the risk of flu-like symptoms need to be weighed against the inconvenience of daily injections. As for newer and novel therapies, their immunosuppressive properties and our less than abundant experience with them need to be balanced against the safety and relative predictability of established treatments.

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