Treatment and therapies


 

At present there is no cure for MS, but its management has improved considerably over the past 25 years. Medications for MS can be classified into three categories:

 

Treatment of an acute relapse [1]


 

Acute relapses are commonly treated with steroids, e.g. intravenous methylprednisolone at a dose of (500mg or) 1000mg daily for 3 to 5 days. Alternatively, high dose oral steroids may also be used. Steroids have shown to be effective at reducing inflammation, shortening the duration of a relapse and accelerating recovery time. Plasma exchange (plasmapheresis) can be used short-term for severe attacks if steroids are contraindicated or ineffective.

 

Disease-modifying therapies


 

Disease-modifying therapies (DMTs) aim to reduce MS activity including relapses and postpone the accumulation of disability (see figure) [2]. With its 1993 approval in the US, BETAFERON became the first DMT available for the treatment of MS [2,3]. In Europe, BETAFERON is indicated for the treatment of a first event suggestive of MS, relapsing-remitting MS and active secondary progressive MS [4]. Over the past 25 years, numerous agents with different modes of action have emerged [2]. The treatment of relapsing forms of MS, in particular, has been a neurology success story [5].

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The concept of disease-modifying therapies

MRI: magnetic resonance imaging

In general, treatment with DMTs leads to [2,6,7]:

  • Fewer relapses (good evidence)
  • Fewer new T2 lesions on MRI (good evidence)
  • Decreased MRI burden of disease (good evidence)
  • Delayed accumulation of disability (mixed evidence)
  • Delayed conversion to secondary progressive MS (difficult to prove, mixed evidence supporting this effect)

 

In general, DMTs are characterized by complex risk-benefit profiles [8]. DMTs considered to be more effective may also carry a higher risk of serious adverse events than, for example, injectables like BETAFERON. These treatments are therefore often restricted to patients with highly active MS or those who do not adequately respond to first-line MS treatments [8,9].

 

BETAFERON is a first-line MS treatment within the class of interferon beta therapies [1,10]. Interferon beta therapies continue to play an important role in the treatment of relapsing MS today [11], with a growing body of evidence suggesting long-term benefits such as reduced risk of mortality [12,13] and reassuring safety findings [3]. Confidence is further enhanced with ample outcomes data in interferon beta-exposed pregnancies (pregnancy section) [4], as well as the possibility of breastfeeding while taking interferon beta [4].

 

 

Symptomatic treatments [14]


 

Specific treatment of symptoms is an essential component of managing MS. In general, the aim is to eliminate or at least reduce symptoms that interfere with patients’ ability to function or negatively impact their quality of life. Symptom management strategies include pharmacological treatments, rehabilitation programs, energy conservation and exercise, among others.

 

While good progress has been made in managing symptoms such as spasticity and gait issues, evidence available on managing symptoms like fatigue or cognitive issues remains limited. Furthermore, symptom management may be complex. For instance, a treatment that improves spasticity and pain may worsen mobility. It is therefore crucial for neurologists and other specialists to work closely with each patient to tailor treatment to their individual symptoms.

 

 

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References

  • Kompetenznetz Multiple Sklerose: Qualitätshandbuch, 2020. Available at: www.kompetenznetz-multiplesklerose.de (Accessed March 6, 2020). Return to content
  • Montalban X et al. Mult Scler 2018; 24(2): 96-120. Return to content
  • Reder AT et al. Mult Scler Relat Disord 2014; 3(3): 294-302. Return to content
  • BETAFERON European Summary of Product Characteristics, October 2020. Available at: https://www.ema.europa.eu/en/documents/product-information/betaferon-epar-product-information_en.pdf Return to content
  • Cerqueira JJ et al. J Neurol Neurosurg Psychiatry 2018; PMID 29618493. Return to content
  • Rae-Grant A et al. Neurology 2018; 90(17): 777-88. Return to content
  • Signori A et al. Mult Scler Rel Disord 2016; 6: 57-63. Return to content
  • Reen GK et al. J Neurol Sci 2017; 375: 107-22. Return to content
  • Winkelmann A et al. Nat Rev Neurol 2016; 12: 217-33. Return to content
  • Yamout B et al. Mult Scler Relat Disord 2020; 37: 101459. Return to content
  • Madsen C et al. Brain Behav 2017; 7: e00696. Return to content
  • Goodin DS et al. Neurology 2012; 78: 1315-22. Return to content
  • Kingwell E et al. Brain 2019; 142(5): 1324-33. Return to content
  • MS International Federation. Available at: www.msif.org Return to content
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