What are some promising new treatments for multiple sclerosis?

What are the treatments for multiple sclerosis?

• Answer:

  The three major drugs previously approved for the treatment of MS affect the course of the disease. None of these drugs is a cure, but they can slow disease progression in many patients. Known as the ABC drugs, Avonex and Betaseron are forms of the immune system protein beta interferon, while Copaxone is glatiramer acetate (formerly called copolymer-1). All three have been shown to reduce the rate of relapses in the relapsing-remitting form of MS. Different measurements from tests of each have demonstrated other benefits as well: Avonex may slow the progress of physical impairment, Betaseron may reduce the severity of symptoms, and Copaxone may decrease disability. All three drugs are administered by injection Two major clinical studies were recently completed that focused on the question of whether disease-modifying therapy known to slow the disease, can postpone the development of clinically definitive MS in high risk patients. Data presented at the annual meeting of the American Academy of Neurology in May, 2000, highlighted the different effects of interferon therapy when it was initiated at the earliest recognizable stages of MS versus later.Previous studies with interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) clearly demonstrated benefits in patients with relapsing forms of MS. Moreover, previous treatment with High-dose corticosteroids also delays, but does not prevent the ultimate development of MS. The encouraging message from the CHAMPS study in the United states and the ETOMS study in Europe is that early intervention can reduce the probability of developing clinically definitive MS. Although the ABC drugs stop relapses and may keep patients in relatively good health for the short-term, their long-term success has not been proven and they don't work well for patients who have reached a steadily progressive stage of MS. In the meantime, new approaches to using current therapies are being researched especially using combinations of different types of agents when one agent alone is not effective. Clinical trials are now evaluating the safety and efficacy of combining cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) in patients who do not respond to the ABC drus, and of adding mitoxantrone (Novantrone), prednisone (Prelone), azathioprine (Imuran), or methotrexate (Rheumatrex) to beta-interferon for further benefit. In addition, Miloxzantrone HCI (novantrone), a drug approved for cancer treatment, has been approved for treating patients with advanced or chronic multiple scelereosis.In clinical trials, mitoxantrone reduced the number of relapse episodes and slowed down the disease. Reserved for progressive forms of MS, it is given intravenously by a doctor to help maintain mobility and reduce the number of flare-ups. However, there are serious side effects with the drug including heart problems, nausea, and hair thinning. As reported in the Spring, 2001, Volume 19, No 2 issue of InsideMS, the FDA recently approved the Copaxone Autoject and the Mixject vial adapters to help people using Copaxone self administer the drug. The autoject keeps the syringe steady and hides the needle. The same syringe may be used for both mixing and injecting with the Mixject vial adapters. A similar device is available for patients using Betassseron. Some patients are using the needlefree Biojector 2000 which uses a CO@ cartridge to deliver doses of medication through the skin. The FDA has not approved its use and patients should discuss this with their physician for its use with either Copaxone or Betaseron. Avonex must be injected in the muscle. Immunosuppressant drugs have been used for many years to treat acute exacerbations (relapses). Drugs used include corticosteroids such as prednisone and methylprednisone; the hormone adrenocorticotropic hormone (ACTH); and azathioprine. Recent studies indicate that several days of intravenous methylprednisone may be more effective than other immunosuppressant treatments for acute symptoms. This treatment may require hospitalization. MS causes a large variety of symptoms, and the treatments for these are equally diverse. Most symptoms can be treated and complications avoided with good care and attention from medical professionals. Good health and nutrition remain important preventive measures. Vaccination against influenza can prevent respiratory complications, and contrary to earlier concerns, is not associated with worsening of symptoms. Preventing complications such as pneumonia, bed sores, injuries from falls, or urinary infection requires attention to the primary problems which may cause them. Shortened life spans with MS arealmost always due to complications rather than primary symptoms themselves. Physical therapy helps the person with MS to strengthen and retrain affected muscles; to maintain range of motion to prevent muscle stiffening; to learn to use assistive devices such as canes and walkers; and to learn safer and more energy-efficient ways of moving, sitting, and transferring. Exercise and stretching programs are usually designed by the physical therapist and taught to the patient and caregivers for use at home. Exercise is an important part of maintaining function for the person with MS. Swimming is often recommended, not only for its low-impact workout, but also because it allows strenuous activity without overheating. Occupational therapy helps the person with MS adapt to her environment and adapt the environment to her. The occupational therapist suggests alternate strategies and assistive devices for activities of daily living, such as dressing,feeding, and washing, and evaluates the home and work environment for safety and efficiency improvements that may be made. Training in bowel and bladder care may be needed to prevent or compensate for incontinence. If the urge to urinate becomes great before the bladder is full, some drugs may be helpful, including propantheline bromide (Probanthine), oxybutynin chloride (Ditropan), or imipramine (Tofranil). Baclofen (Lioresal) may relax the sphincter muscle, allowing full emptying. Intermittent catheterization is effective in controlling bladder dysfunction. In this technique, a catheter is used to periodically empty the bladder. Spasticity can be treated with oral medications, including baclofen and diazepam (Valium), or by injection with botulinum toxin (Botox). Spasticity relief may also bring relief from chronic pain. Other more acute types of pain may respond to carbamazepine (Tegretol) or diphenylhydantoin (Dilantin). Low back pain is common from increased use of the back muscles to compensate for weakened legs. Physical therapy and over-the-counter pain relievers may help. Fatigue may be partially avoidable with changes in the daily routine to allow more frequent rests. Amantadine (Symmetrel) and pemoline (Cylert) may improve alertness and lessen fatigue. Visual disturbances often respond to corticosteroids. Other symptoms that may be treated with drugs include seizures, vertigo, and tremor. Myloral, an oral preparation of bovine myelin, has recently been tested in clinical trials for its effectiveness in reducing the frequency and severity of relapses. Preliminary data indicate no difference between it and placebo. Source: The Gale Group. Gale Encyclopedia of Medicine, 3rd ed.";