oa SA Pharmaceutical Journal - Multiple sclerosis : an overview of current and novel therapies : review
Multiple sclerosis (MS) is believed to be an autoimmune disease of the white matter of the Central Nervous System and typically presents as inflammatory plaques in the brain, spinal cord and optic nerves. Cerebral atrophy and axonal loss may be related to a neurodegenerative process and result in chronic neurological disability.
The condition is diagnosed by clinical symptoms and investigations such as MRI scan confirming that the lesions are separated in time and location. Disease course is unpredictable, ranging from benign to aggressive, with various subtypes with/without relapses and progression. Relapsing remitting MS is the most common presentation.
The treatment of MS has been delineated to include symptomatic control, immunosuppression and immunomodulation. Immunosuppression with corticosteroids is used to treat the acute relapses. On the other hand, immunomodulation is aimed at preventing relapses and changing the course of the disease.
Beta-interferons are currently the disease-modifying treatment of choice as they reduce relapses. Glatiramer acetate also reduces relapse frequency. These drugs are directed at the inflammatory components of MS, but effects on the neurodegenerative components are not confirmed. It is therefore debatable whether these medicines slow down disease progression.
Adverse effects, cost, route and frequency of administration and neutralising antibodies are of concern with interferons. Subsequently, there is research to develop affordable drugs with less adverse effects and more favourable effects on relapses and long-term disability.
Alemtuzumab, a monoclonal antibody, has shown superior efficacy as compared to interferon in clinical trials. Unfortunately, immune thrombocytopaenic purpura (rare) and autoimmune thyroid dysfunction may limit the use of this agent in clinical practice.
There is no cure for MS and there are still many unresolved issues pertaining to appropriate treatment. The main challenges are to identify patients who will deteriorate faster and to develop drugs that target the progressive stage.
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