Treatment of multiple sclerosis with newer immune-modulating drugs

Abstract

Multiple sclerosis can be a severely disabling disease. Recently introduced immunomodulatory drugs (interferon beta or glatiramer acetate) should be considered for the treatment of patients in the earlier stages of the disease, if they have a relapsing-remitting course. These therapies have replaced older immunosuppressants such as methotrexate, at this stage of the disease. On average, immunomodulatory drugs reduce relapse rates by about 30% and retard the progression of disability by about 12-18 months. Whilst these benefits are relatively modest, they offer for the first time a means to alter the natural history of the disease. Several studies suggest that the positive effects of these drugs on the rate of progression of disability and relapse frequency are maintained over time. They all need to be given by frequent injections, and regular monitoring of their adverse effects is a necessary part of management. Immunomodulatory drugs have been used in multiple sclerosis patients intensively for at least 10 years without any apparent long-term adverse effects.