Disease Modifying Agents for Multiple Sclerosis



Olga Hilas*, 1, 2, Priti N Patel3, Sum Lam3, 4
1 St. John’s University College of Pharmacy and Allied Health Professions, Queens, NY, USA
2 Department of Pharmacy. New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA
3 Department of Clinical Pharmacy Practice, St. John’s University, College of Pharmacy and Allied Health Professions, Queens, NY, USA
4 Divisions of Geriatric Medicine & Pharmacy, Winthrop University Hospital, Mineola, New York, USA


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© Hilas et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the St. John’s University College of Pharmacy and Allied Health Professions, Queens, NY; Clinical Coordinator of Internal Medicine/Geriatrics, Department of Pharmacy. New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA; Tel: (718) 990-1887; Fax: (718) 990-1986; E-mail: hilaso@stjohns.edu


Abstract

Objective:

To summarize major clinical trials which evaluate the efficacy and safety data of approved disease modifying agents for the treatment of various types of multiple sclerosis.

Data Sources:

A MEDLINE (1966 to August 2008) search of clinical trials using the terms multiple sclerosis, interferon, glatiramer, mitoxantrone and natalizumab was performed. A manual bibliographic search was also conducted. English-language articles identified from the searches were evaluated. New agents under investigation in phase 3 clinical trials were identified using www.clinicaltrials.gov.

Study Selection & Data Extraction:

Relevant information was identified and selected based on clinical relevance and evidence-based strength. Prescribing information leaflets were used to provide usual dosage, contraindications, precautions, monitoring parameters and other relevant drug-specific information.

Data Synthesis:

Interferon beta products are more efficacious for the treatment of relapsing-remitting multiple sclerosis. Interferon beta 1-b also delayed the time to diagnosis of definite multiple sclerosis and reduced brain lesion burden in patients with clinical isolated syndrome. Glatiramer and natalizumab have both established efficacy in relapsing forms of multiple sclerosis; whereas mitoxantrone is more commonly used in patients with advanced disease. There are limited data the comparative efficacy among different disease modifying agents. New agents currently under investigation have showed promising results and may offer more treatment options in the future.

Conclusions:

MS is a complex and devastating disease with challenging treatment considerations and approaches. Interferon beta products continue to be the mainstay of therapy in many patients, however, other treatments are proving to be at least as effective in the management of various types of MS. Newer compounds are being developed and studied with much anticipation and promise for the clinical management of the disease.

Keywords: Multiple sclerosis, disease modifying therapy, immune modulators, interferon beta, glatiramer, mitoxantrone, natalizumab.