Category Archives: Multiple Sclerosis

Disease Modifying Agents in the Treatment of Multiple Sclerosis

Numerous agents have been tested in multiple sclerosis and the vast majority of these have either failed to show a beneficial effect or produced undesirable side effects. In some cases, there was worsening of disease activity. Treatment strategies for multiple sclerosis over the last 16 years have undergone a profound change. Several treatment options are… Read More »

Disease Modifying Agents in the Treatment of Multiple Sclerosis: Currently Approved Agents

Interferons Interferons (IFN) act through cell receptors producing a variety of immu-nological and antiviral effects. Although the exact mechanism of action in multiple sclerosis is unknown, an anti-inflammatory effect may be the result of inhibition of interferon gamma, inhibition of T-cell activation, production of anti-inflammatory cytokines, reduced T-cell migration, decrease blood brain barrier permeability, or… Read More »

Other Off-Label Agents Used in the Treatment of RRMS

Corticosteroids Corticosteroids are considered as standard treatment for acute relapses. Corticosteroids decrease inflammation and stabilize the blood brain barrier, resulting in more rapid recovery from relapses. The standard dose is 1 g of methylprednisolone (MP) daily for 3-5 days through I/V infusion, although other regimens also have been used. Some studies have suggested that oral… Read More »

Disease Modifying Oral Agents in the Treatment of Multiple Sclerosis

Cladribine Cladribine reduces lymphocyte counts selectively by getting incorporated into dividing cells leading to DNA damage and cell death. It has long-lasting effects and is currently approved for the treatment of hairy cell leukemia. When tested in the intravenous and subcutaneous forms, treatment of a mixed population of multiple sclerosis patients produced a clear beneficial… Read More »

Combination Therapy in Multiple Sclerosis

The treatment of multiple sclerosis (MS) has been revolutionalized over the past decade. Just 12 years ago, multiple sclerosis was not considered a treatable neurologic illness and our therapeutic armamentarium consisted largely of symptomatic therapies and corticosteroids to treat acute exacerbations. Currently, there are five drugs [the three beta interferons (IFNs) (Avonex®, Betaseron®, and Rebif®),… Read More »

Therapy in Multiple Sclerosis: IFNβ and Glatiramer Acetate

IFNβ and Glatiramer Acetate are well suited for testing their combinatorial potential, as their mechanisms of action differ and could be complimentary. Furthermore, when used alone, they are partially effective, safe, and generally well tolerated. The therapeutic effects of IFN may be due to its antiproliferative action; down-regulation of costimulatory molecules; decrease of proinflammatory cytokines;… Read More »

Therapy in Multiple Sclerosis: IFN, Methylprednisolone, and Methotrexate

Corticosteroids have anti-inflammatory and immunosuppressive properties and have been used to treat acute multiple sclerosis exacerbations for more than 30 years. While periodic pulses of intravenous (IV) methylprednisolone are not effective in preventing disability in patients with progressive MS, a phase II trial concluded that they do have an effect on disability, brain atrophy, and… Read More »

Mitoxantrone in Multiple Sclerosis

Mitoxantrone () was developed in the 1970s and is an antineoplastic agent. It is an anthracenedione derivative related to the anthracyclins doxorubicine and daunorubicine. It interacts with topoisomerase-2, stabilizes its cleavable complex with DNA, thus prevents the ligation of DNA strands, and consecutively delays the cell-cycle progression. Mitoxantrone is used to effectively treat malignancies such… Read More »

Glatiramer Acetate (Copaxone)

The past 15 years have seen a revolution in our understanding and management of many neurologic diseases, including multiple sclerosis (MS). The US Food and Drug Administration (FDA) approved the first of the interferon (IFN) preparations, IFNβ-1b (Betaseron®) for multiple sclerosis in 1993, followed by glatiramer acetate (Glatiramer Acetate, Copaxone®) in 1995, intramuscular IFNβ-1a (Avonex®)… Read More »

Clinical Studies Of Glatiramer Acetate

Clinical Trials Of Glatiramer Acetate In Relapsing-Remitting Multiple Sclerosis Clinical Trials Of Glatiramer Acetate In Progressive Forms Of Multiple Sclerosis MRI Studies Adverse Events in Trials and Clinical Experience Adverse events in the various Glatiramer Acetate studies were numerous, but relatively mild, and this has been borne out in clinical practice. There were no hematologic… Read More »