Clinical Review Regular review

Drug treatment of multiple sclerosis

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.490 (Published 19 August 2000) Cite this as: BMJ 2000;321:490
  1. C H Polman, professor (ch.polman@azvu.nl),
  2. B M J Uitdehaag, neurologist
  1. Department of Neurology, Academic Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, Netherlands
  1. Correspondence to: C H Polman

    Multiple sclerosis is the most common cause of chronic neurological disability in young adults, with a prevalence of about 1 in 1000. About 50% of patients are unable to walk without assistance 15 years after onset. As yet, no treatment can halt the accumulation of disability. In recent years, however, there has been substantial progress in understanding the pathogenetic mechanisms of the disease and in developing techniques to monitor treatment. Based on this progress treatments were developed that have a favourable impact on the natural course of the disease (disease modifying drugs). We discuss the evidence available from large randomised, placebo controlled studies, and we address several questions that still generate wide interest in relation to treatment with disease modifying drugs. Treatment of symptoms and rehabilitation, which still remain the mainstay of treatment for most patients with multiple sclerosis, are not reviewed here.

    Summary points

    • Disease modifying treatment should be considered early in the course of multiple sclerosis for patients with an unfavourable prognosis

    • Considerable dispute still exists among experts about the optimal time to start treatment

    • Interferon beta is the first line treatment for relapsing-remitting multiple sclerosis

    • Glatiramer acetate—although not yet available in several European countries—has comparable efficacy in relapsing-remitting multiple sclerosis

    • Future trial results are crucial to assess the role of interferon beta in secondary progressive multiple sclerosis

    • Magnetic resonance imaging has an important role in better understanding the treatment response in multiple sclerosis

    Methods

    We have concentrated mainly on drugs that have been specifically approved for use in multiple sclerosis. Our sources included papers from Medline, information from international meetings on multiple sclerosis, and ongoing discussions with colleagues.

    Multiple sclerosis

    Clinical course

    Multiple sclerosis usually manifests clinically in the third or fourth decade, typically presenting with a relapsing-remitting course which, after a period of time (average 5–15 years), in most patients is followed by …

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