Review article
MULTIPLE SCLEROSIS TREATMENT
LUCIJA ZADRO MATOVINA
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
MILJENKA JELENA JURAŠIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
IRIS ZAVOREO
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
NEVENA GRBIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
VANJA BAŠIĆ KES
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, University of Zagreb, School of Dental Medicine, Zagreb and Josip Juraj Strossmayer University of Osi
Abstract
Introduction: Lately, treating multiple sclerosis is becoming ever more challenging. It includes a combination of immunomodulatory and symptomatic treatments. There is an expansion of immunomodulatory agents, especially monoclonal antibodies. New drugs to treat relapse-remittent multiple sclerosis (RRMS) and a drug for primary progressive multiple sclerosis have been introduced. Also, a new concept of treating, named No Evidence of Disease Activity (NEDA) appeared with an aim to achieve a patient that is free of relapses, free of new EDSS deteriorations, free of new or newly enlarged lesions on magnetic resonance imaging, and free of brain atrophy. It would encompass early diagnosis, early therapy implementation, and the possibility of therapy changing. To achieve NEDA, two approaches are available, escalating and induction therapy. Escalating therapy includes the use of fi rst-line drugs with the possibility of changing to second-line agents in case of therapy failure. The induction therapy approach considers induction with immunosuppressants followed by maintenance therapy with immunomodulatory agents. Aim: Our aim was to search through scientifi cally published papers for medically valid data in order to provide the best medical advice for both physicians and patients in search for appropriate treatment. Methods: We performed extensive MEDLINE search, dating from 1993. Results and Discussion: The interferons, glatiramer acetate, terifl unomide and dimethyl fumarate are considered as the fi rst-line RRMS therapy, while other available medications represent second- or even third-line therapy. Avonex, Betaseron, Extavia, Glatopa and Copaxone can be utilized as an early treatment of clinically isolated syndrome. Ocrelizumab is a monoclonal antibody used to treat primary progressive form of multiple sclerosis. Secondary progressive multiple sclerosis can presumably be treated with interferon beta, terifl unomide, fi ngolimod, alemtuzumab and dimethyl fumarate while they express an effect on disease activity control, otherwise mitoxantrone is another option available. Conclusion: The goal would be to collect as much data as possible and re-evaluate all relevant data on multiple sclerosis immunomodulatory therapy that does not include monoclonal antibodies. Also, the goal would be to notice adverse effects and special recommendations on pre-treatment
concerns, as much as control of certain parameters during and after the application of disease modifying agents. The best approach to patient management is through multiple sclerosis centers where interdisciplinary team can effectively resolve all the concomitant events.
Keywords
multiple sclerosis; NEDA; EDSS scale; immunomodulatory therapy; treatment
Hrčak ID:
208630
URI
Publication date:
16.11.2018.
Visits: 7.397 *