Recent Advances in the Management of Multiple Sclerosis

Pozzilli C, Prosperini L.  Recent Advances in the Management of Multiple Sclerosis.  European Neurological Journal, June 2010; 2(1):  41-48

Review Article

Carlo Pozzilli and Luca Prosperini

Affiliation: Multiple Sclerosis Centre, S. Andrea Hospital, Department of Neurological Sciences, ‘‘La Sapienza’’ University, Rome, Italy

ABSTRACT

Over the last few decades, there have been significant advances in the diagnosis and management of multiple sclerosis (MS), and treatment options for MS have broadened dramatically. The advent of disease‐modifying therapies (DMTs) has changed the clinical and social burden of this disease. First‐line therapies, e.g., interferon beta (IFNB) and glatiramer acetate (GA), are safe, but only partially effective, and in several cases, they are poorly tolerated by patients. Pharmacological and non‐pharmacological interventions, such as nursing support, auto‐injector devices, and patient education programs, may enhance adherence to injected drugs. Comparison studies have demonstrated a substantial equivalence of efficacy between IFNB and GA. Monitoring patient response to first‐line therapies and improving their tolerability represent the primary objectives in the management of treated patients. Second‐line therapies, such as natalizumab or mitoxantrone, are indicated for those patients with breakthrough disease despite first‐line treatment, or with a rapidly evolving course of MS. Safety concerns of second‐line drugs and the lack of long‐term safety data require accurate patient selection and monitoring during treatment. Oral treatments and other monoclonal antibodies will be available in the next few years to improve our armamentarium for the treatment of MS. The present review provides a description of the latest advances in the available therapy for the management of MS and describes the state of promising therapies currently under study.

Keywords: multiple sclerosis, interferon beta, glatiramer acetate, natalizumab, mitoxantrone, oral drugs, monoclonal antibodies
Correspondence: Carlo Pozzilli, Multiple Sclerosis Centre, S. Andrea Hospital, Department of Neurological Sciences, “La Sapienza” University, Via di Grottarossa, 1035, 00189, Rome, Italy. Tel: (39)‐06‐33775686; Fax: (39)‐06‐33775900; e‐mail: carlo.pozzilli@uniroma1.it