Multiple sclerosis: A review of current treatments for physicians

A review of the literature on treating multiple sclerosis (MS) aims to provide physicians with evidence-based information on the latest treatments for this chronic disease. The article, published in CMAJ (Canadian Medical Association Journal) looks at the latest pharmacologic research as well as disease-modifying agents and the benefits and risks of various treatments.

"Recently, several new compounds have been developed and approved with the aim of favourably changing the disease course, but with varied success," writes Dr. Loredana La Mantia, Cochrane Multiple Sclerosis Cochrane and Rare Diseases of the Central Nervous System Group, Milan Italy, with coauthors. "The evaluation of the effectiveness of treatments for MS is complex, and identifying the most appropriate treatment for an individual patient may be difficult."

Steroids are the most effective way of treating relapses, with intravenous use of methylprednisolone the usual treatment. A systematic review showed "that oral and intravenous administration of steroids may have similar efficacies" and "could have a substantial impact on clinical practice by allowing outpatient instead of hospital management of relapses in many instances," write the authors.

They discuss the benefits and risks of immunosuppressants such as natalizumab, fingolimod and others as well as new treatments under investigation.

"Several important areas of the pharmacologic management of MS need further investigation. The long-term efficacy of drug treatments is unknown in terms of the accumulation of disability and the prognosis of relapsing-remitting MS. A better understanding of the neuroprotective effects of available drugs and newer compounds is needed," the authors conclude.

More information: Journal paper: www.cmaj.ca/lookup/doi/10.1503/cmaj.130727

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