A clinician's approach to modulate disease activity in MS.
All multiple sclerosis (MS) patients should have their treatment profile carefully evaluated as to disease control, optimal therapy, and adverse side effects at every clinical visit, with the goal of safely minimizing disease activity. There is a general consensus among clinicians that therapy should be initiated early in the course of the disease and should be continued indefinitely unless disease activity continues, intolerable side effects develop, patient transitions to a primary progressive course, or more effective and safer drugs become available. Patients for whom treatment is delayed should be seen at least every 6 months, and therapy should be initiated if new disease activity is found. Magnetic resonance imaging is the most practical laboratory test currently available for monitoring ongoing tissue injury and is useful when evaluating the efficacy of a given therapy. Four immunomodulators and 2 immunosuppressants are currently approved for the treatment of relapsing or secondary progressive forms of MS; in addition, various immunosuppressive or immunomodulating drugs have been used off-label, alone or in combination, in clinical practice. Many issues remain to be resolved in attempting to modulate disease activity in MS patients. Consequently, the art of medicine and clinical judgment become important aspects of MS patient care.
Cook
Stuart D
SD
Department of Neurology and Neurosciences, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
D002490:Central Nervous System / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D002985:Clinical Protocols / Q000592:standards; D003663:Decision Trees; D018450:Disease Progression; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000592:standards; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D055502:Secondary Prevention; D016896:Treatment Outcome
D007155:Immunologic Factors; D007166:Immunosuppressive Agents