title: Induction vs. escalation of therapy for relapsing multiple sclerosis: the evidence.
abstract: Not all patients presenting with their first attack of multiple sclerosis (MS) or early thereafter are necessarily in the same phase of disease; some truly present early with minimal disease, whereas others present late, having accumulated already considerable damage to the central nervous system (CNS). This beckons a different approach to therapy depending on "where" a patient may be in the course of disease. If early, then any of the current first line immunomodulating agents may be appropriate, whereas later disease calls for a more aggressive approach entailing either induction with a more powerful but riskier treatment or an escalation approach, moving through first line agents and stepping up to more aggressive treatments. This paper discusses the rationale for either regimen.
authors.affiliation: Multiple Sclerosis Research Unit, The Ottawa Hospital General Campus, University of Ottawa, Ottawa, Canada. mfreedman@ottawahospital.on.ca
authors.forename: Mark S
authors.initials: MS
authors.lastname: Freedman
mesh_terms: D018450:Disease Progression; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D007165:Immunosuppression Therapy / Q000379:methods* / Q000592:standards; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D018570:Risk Assessment; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D007155:Immunologic Factors