Induction vs. escalation of therapy for relapsing multiple sclerosis: the evidence.
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.
Freedman
Mark S
MS
Multiple Sclerosis Research Unit, The Ottawa Hospital General Campus, University of Ottawa, Ottawa, Canada. mfreedman@ottawahospital.on.ca
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
D007155:Immunologic Factors