title: Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 2 new and emerging therapies and their efficacy. MS Neurology Group of the Australian and New Zealand Association of Neurologists.
abstract: In Part 2 of this three part review of multiple sclerosis (MS) treatment with a particular focus on the Australian and New Zealand perspective, we review the newer therapies that have recently become available and emerging therapies that have now completed phase III clinical trial programs. We go on to compare the relative efficacies of these newer and emerging therapies alongside the existing therapies. The effectiveness of β-interferon in the treatment of different stages and the different disease courses of MS is critically reviewed with the conclusion that the absolute level of response in term of annualised relapse rates (where relapses occur) and MRI activity are similar, but are disappointing in terms of sustained disability progression for progressive forms of the disease. Finally we review the controversial area of combination therapy for MS. Whilst it remains the case that we have no cure or means of preventing MS, we do have a range of effective therapies that when used appropriately and early in the disease course can have a significant impact on short term and longer term outcomes.
authors.affiliation: School of Medicine, Griffith University, Gold Coast Campus, QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia. Electronic address: simon.broadley@griffith.edu.au.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Broadley
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Barnett
authors.affiliation: Department of Neurology, The Townsville Hospital, Douglas, QLD, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: Boggild
authors.affiliation: Department of Neurology and St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Brew
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Department of Neurology, Eastern Health and Monash University, 2/5 Arnold Street, Box Hill VIC 3128, Australia.
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
authors.affiliation: Westmead Clinical School, University of Sydney, NSW, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Heard
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, NSW, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hodgkinson
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, University of Western Australia, WA, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, WA, Australia.
authors.forename: Allan G
authors.initials: AG
authors.lastname: Kermode
authors.affiliation: Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW, Australia.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lechner-Scott
authors.affiliation: Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
authors.forename: Richard A L
authors.initials: RA
authors.lastname: Macdonell
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Marriott
authors.affiliation: Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Deborah F
authors.initials: DF
authors.lastname: Mason
authors.affiliation: Central Clinical School, University of Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Parratt
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Reddel
authors.affiliation: School of Medicine, Deakin University, VIC, Australia.
authors.forename: Cameron P
authors.initials: CP
authors.lastname: Shaw
authors.affiliation: Flinders Medical Centre, Flinders University, SA, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Slee
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Spies
authors.affiliation: Menzies Research Institute, University of Tasmania, TAS, Australia.
authors.forename: Bruce V
authors.initials: BV
authors.lastname: Taylor
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, University of Western Australia, WA, Australia.
authors.forename: William M
authors.initials: WM
authors.lastname: Carroll
authors.affiliation: Menzies Research Institute, University of Tasmania, TAS, Australia.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Kilpatrick
authors.affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: King
authors.affiliation: University of Queensland Centre for Clinical Research, QLD, Australia.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: McCombe
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: Pollard
authors.affiliation: Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Ernest
authors.initials: E
authors.lastname: Willoughby
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D000975:Antioxidants / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D017326:Clinical Trials, Phase III as Topic; D003437:Crotonates / Q000009:adverse effects / Q000627:therapeutic use; D000077561:Daclizumab; D000069462:Dimethyl Fumarate; D019468:Disease Management; D018450:Disease Progression; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005650:Fumarates / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006885:Hydroxybutyrates; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D009570:Nitriles; D015363:Quinolones / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D035703:Therapies, Investigational / Q000639:trends*; D014052:Toluidines / Q000009:adverse effects / Q000627:therapeutic use; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018951:Antigens, CD20; D000975:Antioxidants; D003437:Crotonates; D005650:Fumarates; D006885:Hydroxybutyrates; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D009570:Nitriles; D015363:Quinolones; D014052:Toluidines; C527525:teriflunomide; D000074323:Alemtuzumab; D016899:Interferon-beta; C476223:laquinimod; D000077561:Daclizumab; D000069462:Dimethyl Fumarate
keywords: Evidence-based medicine; Guideline; Multiple sclerosis; Review; Treatment