title: Therapeutic considerations for disease progression in multiple sclerosis: evidence, experience, and future expectations.
abstract: In the management of patients with multiple sclerosis (MS), providers are all faced with the highly formidable challenge of ascertaining whether, and to what degree, disease-modifying therapy is effective in the individual patient. While much has been learned in randomized, controlled clinical trials, we cannot simply extrapolate the outcomes of these initiatives and apply them to the care of a single patient. In the future, the application of pharmacogenetic techniques, proteomics, and microarray analysis will yield novel profiling information on individual patients that will substantially refine the specific therapeutic questions of relevance: (1) What is the best treatment for an individual patient? (2) Which patients require intensive therapeutic combination regimens to optimize control of the disease process? (3) What are the appropriate drug dosing targets for an individual patient? and (4) Which patients will be predisposed to the development of drug-related adverse events? Such data may provide a novel variable of drug responsiveness that will mandate its inclusion into the process of covariate analyses for clinical trials.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. elliot.frohman@utsouthwestern.edu
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Frohman
authors.forename: Olaf
authors.initials: O
authors.lastname: Stüve
authors.forename: Eva
authors.initials: E
authors.lastname: Havrdova
authors.forename: John
authors.initials: J
authors.lastname: Corboy
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.forename: Per Soelberg
authors.initials: PS
authors.lastname: Sorensen
authors.forename: J Theodore
authors.initials: JT
authors.lastname: Phillips
authors.forename: Brian
authors.initials: B
authors.lastname: Weinshenker
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hawker
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.forename: Lawrence
authors.initials: L
authors.lastname: Steinman
authors.forename: Scott
authors.initials: S
authors.lastname: Zamvil
authors.forename: Bruce A C
authors.initials: BA
authors.lastname: Cree
authors.forename: Stephen
authors.initials: S
authors.lastname: Hauser
authors.forename: Howard
authors.initials: H
authors.lastname: Weiner
authors.forename: Michael K
authors.initials: MK
authors.lastname: Racke
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
mesh_terms: D018450:Disease Progression; D006801:Humans; D009103:Multiple Sclerosis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic