The therapy of multiple sclerosis with immune-modulating or immunosuppressive drug. A critical evaluation based upon evidence based parameters and published systematic reviews.
Today many different drugs are available for treatment of multiple sclerosis (MS). Interferons, glatiramer acetate, mitoxantrone, and natalizumab have been approved by the regulatory authorities of many countries for the treatment of MS. Evidence based medicine (EBM) principles allow physicians to better address the correct treatment for patients. This article aimed to review all the clinical trials on immune-modulating and immunosuppressive drugs on the basis of the EBM principles. Based on the evidence to date interferon beta represents the best therapeutic option, particularly if given at high doses and with multiple injections per week. Due to its lower efficacy, glatiramer acetate should be used as a second choice in case of intolerable side effects or toxicity of interferon beta. Great efficacy has been demonstrated for mitoxantrone and natalizumab. These drugs should be, however, used with particular attention for their potential toxic effects.
Clerico
Marinella
M
Dipartimento di Scienze Cliniche e Biologiche, Divisione di Neurologia, Ospedale Universitario, S.Luigi Gonzaga, Universita' di Torino, Torino, Italy.
Rivoiro
Chiara
C
Contessa
Giulia
G
Viglietti
Daniela
D
Durelli
Luca
L
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D019317:Evidence-Based Medicine; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016899:Interferon-beta / Q000009:adverse effects / Q000627:therapeutic use; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000628:therapy*; D000069442:Natalizumab; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D008942:Mitoxantrone