Latest recommendations for treating MS
In 2002, after a thorough review of all the available evidence, the American Academy of Neurology published its Clinical Practice Guidelines on disease modifying therapies for MS. They based their recommendations on the results of a number of clinical trials, giving special weight to those that they considered to be well designed and scientifically sound. They gave four ratings for their recommendations:
- Established as effective or otherwise
- Probably effective or otherwise
- Possibly effective or otherwise
- Unproven
Their main recommendations are as follows:
(after Goodin et al 2002)1
Beta interferon
Beta interferon should be considered for any patient who is at high risk of developing clinically defined MS or already has relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) and is still experiencing relapses.
The effectiveness of beta interferon in patients with SPMS not experiencing relapses is uncertain.
Beta interferon reduces the attack rate measured both clinically and by MRI findings in patients with MS or clinically isolated syndromes i.e. those who have had a single attack of MS-type symptoms but have not had MS confirmed.
Beta interferon probably slows sustained disability progression.
It is possible that some MS patients, such as those with more attacks or at an earlier disease stage, are better candidates for beta interferon therapy.
It is probable that increasing the dose of beta interferon increases its effectiveness, but this may be due to an increased frequency of administration rather than a higher dose.
Glatiramer acetate
Glatiramer acetate should be considered in any patient with RRMS to reduce the attack rate.
Glatiramer acetate may possibly slow sustained progression of disability in RRMS.
There is no evidence to support the use of glatiramer acetate in progressive disease.
Glucocorticoids
Glucocorticoid treatment has been demonstrated to have short-term benefit for any patient with an acute MS attack. Although they do not appear to have any long term functional benefit.
It is possible that regular pulses of glucucorticoids may be useful in the long term management of RRMS.
Other treatments
The following treatments may possibly offer benefit for some MS patients:
Cyclophosphosphamide (younger patients with progressive disease)
Methotrexate
Azathioprine
Cladribine
Cyclosporin (potential benefits outweighed by the risk of side effects)
Mitoxantrone (potential benefits outweighed by the risk of side effects)
Intravenous immunoglobulin
Plasma exchange (in severe acute episodes in previously non-disabled patients)
Reference
1 Goodin DS, Frohman EM et al. Disease modifying therapies in multiople sclerosis. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002;58:169-178.
