title: Disease-modifying agents in progressive multiple sclerosis: management of 100 patients at Louis Stokes Cleveland VAMC, Spinal Cord Injury Division.
abstract: Multiple sclerosis (MS) is a chronic disease in which disability progresses over time. Progressive forms of MS have a poor prognosis, are associated with greater levels of disability and, unfortunately, are unresponsive to current treatments. Here, we have reviewed the management of 100 patients with MS. The majority of these patients had progressive disease, Expanded Disability Status Scale scores >6, and extensive medical complications. A significant number of patients in this cohort were also treated with MS disease-modifying agents that lack efficacy in patients with progressive disease. Although these drugs are relatively safe, their use here is significantly costly to the healthcare system, with limited benefit to patients. We suggest that these drugs be discontinued in these patients and resources be directed toward symptomatic treatment, rehabilitation needs, and management of medical complications until drugs with proven efficacy become available.
authors.affiliation: Departments of Neuroscience and Neurology, Case Western Reserve School of Medicine, Cleveland, OH, USA.
authors.forename: Saisho
authors.initials: S
authors.lastname: Mangla
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.forename: Stephen
authors.initials: S
authors.lastname: Selkirk
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D019468:Disease Management; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use*; D016899:Interferon-beta / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy* / Q000191:economics; D009820:Ohio; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016899:Interferon-beta