Disease-modifying agents in the treatment of multiple sclerosis: a review of long-term outcomes.
Multiple sclerosis (MS) is a chronic, debilitating condition mediated by inflammation and neurodegeneration. The ultimate goal of treatment is to delay or halt the progression of irreversible disability. Disease-modifying drugs (DMDs), including beta interferon and glatiramer acetate during phase III trails, have been shown to reduce relapse rates in relapsing-remitting multiple sclerosis (RRMS) as detected by magnetic resonance imaging (MRI). However, the long-term effects of DMDs on MS progression are not very clear; therefore, the aim of this paper is to evaluate the evidence available of the long-term effects of DMDs on reducing the progression of multiple sclerosis. A number of open-label, prospective extensions that followed a cohort of patients enrolled in double-blind, placebo-controlled trials were examined. Methodological difficulties faced in designing a trial of extended duration were hard to overcome, however, and long-term, open-label extensions of interferon and glatiramer acetate failed to show significant beneficial effects in delaying disability progression, questioning the cost-effectiveness of these therapies in the long-term.
Katrych
Oleksandra
O
Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, New York 12144, USA.
Simone
Tessa M
TM
Azad
Shara
S
Mousa
Shaker A
SA
D017326:Clinical Trials, Phase III as Topic / Q000379:methods; D015331:Cohort Studies; D004311:Double-Blind Method; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D009103:Multiple Sclerosis / Q000188:drug therapy*; D010455:Peptides / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D007155:Immunologic Factors; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta